The forced oscillation technique in clinical practice: methodology, recommendations and future developments. E. Oostveen, D. MacLeod, H. Lorino, R. Farre´ , Z. Hantos, K. Desager, F. Marchal, on behalf of the ERS Task Force on Respiratory Impedance Measurements. #ERS Journals Ltd 2003. ABSTRACT: The forced oscillation technique (FOT) is a noninvasivemethod with which to measure respiratory mechanics. FOT employs small-amplitude pressure oscillations superimposed on the normal breathing and therefore has the advantage over conventional lung function techniques that it does not require the performance of respiratory manoeuvres. The present European Respiratory Society Task Force Report describes the basic prin- ciple of the technique and gives guidelines for the application and interpretation of FOT as a routine lung function test in the clinical setting, for both adult and paediatric populations. FOT data, especially those measured at the lower frequencies, are sensitive to airway obstruction, but do not discriminate between obstructive and restrictive lung disorders. There is no consensus regarding the sensitivity of FOT for bronchodilation testing in adults. Values of respiratory resistance have proved sensitive to bronchodilation in children, although the reported cutoff levels remain to be cone rmed in future studies. Forced oscillation technique is a reliable method in the assessment of bronchial hyper- responsiveness in adults and children. Moreover, in contrast with spirometry where a deep inspiration is needed,forced oscillation techniquedoes not modifytheairway smooth muscle tone. Forced oscillation technique has been shown to be as sensitive as spirometry in detecting impairments of lung function due to smoking or exposure to occupational hazards. Together with the minimalrequirement for the subject 9s cooperation, this makes forced oscillation technique an ideal lung function test for epidemiological and e eld studies. Novel applications of forced oscillation technique in the clinical setting include the monitoring of respiratory mechanics during mechanical ventilation and sleep.

https://erj.ersjournals.com/content/erj/22/6/1026.full.pdf

The forced oscillation technique in clinical practice: methodology, recommendations and future developments

Oscillometry (also known as the forced oscillation technique) measures the mechanical properties of the respiratory system (upper and intrathoracic airways, lung tissue and chest wall) during quiet tidal breathing, by the application of an oscillating pressure signal (input or forcing signal), most commonly at the mouth. With increased clinical and research use, it is critical that all technical details of the hardware design, signal processing and analyses, and testing protocols are transparent and clearly reported to allow standardisation, comparison and replication of clinical and research studies. Because of this need, an update of the 2003 European Respiratory Society (ERS) technical standards document was produced by an ERS task force of experts who are active in clinical oscillometry research.The aim of the task force was to provide technical recommendations regarding oscillometry measurement including hardware, software, testing protocols and quality control.The main changes in this update, compared with the 2003 ERS task force document are 1) new quality control procedures which reflect use of "within-breath" analysis, and methods of handling artefacts; 2) recommendation to disclose signal processing, quality control, artefact handling and breathing protocols (e.g. number and duration of acquisitions) in reports and publications to allow comparability and replication between devices and laboratories; 3) a summary review of new data to support threshold values for bronchodilator and bronchial challenge tests; and 4) updated list of predicted impedance values in adults and children.

https://erj.ersjournals.com/content/erj/55/2/1900753.full.pdf

Technical Standards for Respiratory Oscillometry

Clinical application of forced oscillation.

In recent years the greatest progress in our understanding of pneumoconioses, other than those produced by asbestos, silica, and coal, has been in the arena of metal-induced parenchymal lung disorders. Inhalation of metal dusts and fumes can induce a wide range of lung pathology, including airways disorders, cancer, and parenchymal diseases. The emphasis of this update is on parenchymal diseases caused by metal inhalation, including granulomatous disease, giant cell interstitial pneumonitis, chemical pneumonitis, and interstitial fibrosis, among others. The clinical characteristics, epidemiology, and pathogenesis of disorders arising from exposure to aluminum, beryllium, cadmium, cobalt, copper, iron, mercury, and nickel are presented in detail. Metal fume fever, an inhalation fever syndrome attributed to exposure to a number of metals, is also discussed. Advances in our knowledge of antigen-specific immunologic reactions in the lung are particularly evident in disorders secondary to beryllium and nickel exposure, where immunologic mechanisms have been well characterized. For example, current evidence suggests that beryllium acts as an antigen, or hapten, and is presented by antigen-presenting cells to CD4+ T cells, which possess specific surface antigen receptors. Other metals such as cadmium and mercury induce nonspecific damage, probably by initiating production of reactive oxygen species. Additionally, genetic susceptibility markers associated with increased risk have been identified in some metal-related diseases such as chronic beryllium disease and hard metal disease. Future research needs include development of biologic markers of metal-induced immunologic disease, detailed characterization of human exposure, examination of gene alleles that might confer risk, and association of exposure data with that of genetic susceptibility.

Inorganic DustPneumonias: TheMetal-Related Parenchymal Disorders

https://americansleepandbreathingacademy.com/wp-content/uploads/2015/08/IOS-WTC.pdf

Respiratory symptoms and physiologic assessment of ironworkers at the World Trade Center disaster site.

Following the occurrence of metal fume fever in some subjects after the installation of an electric furnace in a steel plant, a survey was undertaken to examine whether subjects exposed to fumes containing zinc oxide would exhibit a detectable impairment in ventilatory function, and whether a forced oscillation technique (FOT) was more suited for this detection than conventional spirometry. Pulmonary function measurements were made in 57 exposed workers (production or maintenance) and 55 nonexposed workers (maintenance or strandcasting department) at the beginning and near the end of a work shift (day or night). Maximal expiratory volumes and flows were measured by means of a pneumotachograph, and respiratory resistance (Rrs) and reactance at various frequencies by means of a FOT. These measurements were repeated 1 day later. During the day shift, there were no significant differences in pulmonary function between exposed and control workers. However, during the night shift, an influence of exposure on pulmonary function was revealed both by spirometry and by FOT: workers exposed at night showed a slight decrease in vital capacity (VC) and in forced expiratory volume in one second (FEV1), and a decline in respiratory resistance (Rrs) with oscillation frequency, that were more marked than in unexposed subjects. In contrast to the frequency dependence of Rrs, the changes of lung volumes and expiratory flows were related to differences in initial values between exposed and nonexposed workers. The decrease in FEV1 was maintained the day after exposure. The forced oscillation technique proved at least as sensitive as spirometry to detect small across-shift changes in ventilatory function. Although the effects on pulmonary function were small, it is likely that they represent a subclinical response to the inhalation of small quantities of zinc oxide.

https://erj.ersjournals.com/content/erj/10/7/1523.full.pdf

Short-term ventilatory effects in workers exposed to fumes containing zinc oxide : comparison of forced oscillation technique with spirometry

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Short-term ventilatory effects in workers exposed to fumes containing zinc oxide : comparison of forced oscillation technique with spirometry