Pneumology - Original Articles Open access

Comparative evaluation of impulse oscillometry and spirometry for the detection of small airway disease in patients with obstructive airway diseases

Authors

Published
11 November 2026
Issue
Early Access
Section
Pneumology - Original Articles
DOI
10.4081/monaldi.2026.3663

Abstract

Although there is some evidence supporting a correlation between impulse oscillometry (IOS) and spirometry for detecting small airway disease (SAD), in many cases, discordant results are observed. IOS has not yet been established as a standard method for routine pulmonary function assessment in clinical practice. We did this study with the primary objective of diagnosing SAD in patients with obstructive airway diseases (OAD) using IOS and comparing it with spirometry. This cross-sectional, comparative study was conducted from July 2023 to December 2024. Adult patients (≥18 years of age) with diagnosed stable OADs [asthma, chronic obstructive pulmonary disease (COPD), and bronchiectasis] were included in the study (n=118). Maximum expiratory flow 25-75 with a Z score of <-1.64 and resistance at 5 Hz - resistance at 20 Hz (R5-R20) >150% were criteria used for defining small airway obstruction in spirometry and IOS, respectively, and were compared. As secondary outcomes, correlation of severity of SAD across COPD groups, Global Initiative for Asthma (GINA) steps using IOS, and comparison of bronchodilatation responsiveness (BDR) were also done. In pre-BDR, IOS and spirometry diagnosed SAD in 94.91% and 82.20% of patients, respectively (p=0.069). There was poor agreement (ĸ=0.155) between these modalities pre-BDR; however, post-BDR, there was fair agreement (ĸ=0.277) between these modalities, and both modalities for the detection of SAD were significantly related (p=0.003). Across various Global Initiative for Chronic Obstructive Lung Disease groups, there was no significant difference in the severity of SAD, while across various GINA steps, there was a significant difference in the severity of SAD, especially GINA step 1-2 and step 5. There was poor agreement between these modalities for the BDR test. In conclusion, both modalities performed differently in pre-BDR (discordant) and post-BDR (concordant) settings. For the BDR test, both modalities are not exchangeable. Further research is warranted to determine the optimal setting (pre-BDR vs. post-BDR).

Keywords

Ethics Approval

The study protocol was approved by the Institutional Ethics Committee with office no: IEC/VMMC/SJH/Thesis/05-2023/12.

References

  1. Hogg JC, Chu F, Utokaparch S, et al. The nature of small-airway obstruction in chronic obstructive pulmonary disease. N Engl J Med 2004;350:2645-53. DOI: https://doi.org/10.1056/NEJMoa032158
  2. Contoli M, Bousquet J, Fabbri LM, et al. The small airways and distal lung compartment in asthma and COPD: a time for reappraisal. Allergy 2010;65:141-51. DOI: https://doi.org/10.1111/j.1398-9995.2009.02242.x
  3. Ranga V, Kleinerman J. Structure and function of small airways in health and disease. Arch Pathol Lab Med 1978;102:609-17.
  4. McNulty W, Usmani OS. Techniques of assessing small airways dysfunction. Eur Clin Respir J 2014;17:1. DOI: https://doi.org/10.3402/ecrj.v1.25898
  5. Verbanck S. Physiological measurement of the small airways. Respiration 2012;84:177-88. DOI: https://doi.org/10.1159/000341742
  6. McFadden ER Jr, Linden DA. A reduction in maximum mid-expiratory flow rate. A spirographic manifestation of small airway disease. Am J Med 1972;52:725-37. DOI: https://doi.org/10.1016/0002-9343(72)90078-2
  7. Desiraju K, Agrawal A. Impulse oscillometry: the state-of-art for lung function testing. Lung India 2016;33:410-6. DOI: https://doi.org/10.4103/0970-2113.184875
  8. Crisafulli E, Pisi R, Aiello M, et al. Prevalence of small-airway dysfunction among COPD patients with different GOLD stages and its role in the impact of disease. Respiration 2017;93:32-41. DOI: https://doi.org/10.1159/000452479
  9. Usmani OS, Singh D, Spinola M, et al. The prevalence of small airways disease in adult asthma: a systematic literature review. Respir Med 2016;116:19-27. DOI: https://doi.org/10.1016/j.rmed.2016.05.006
  10. Cottini M, Lombardi C, Comberiati P, et al. Small airway dysfunction and impulse oscillometry in adult patients with asthma: recent findings. Explor Asthma Allergy 2023;1:163-73. DOI: https://doi.org/10.37349/eaa.2023.00017
  11. Usmani OS, Dhand R, Lavorini F, Price D. Why we should target small airways disease in our management of chronic obstructive pulmonary disease. Mayo Clin Proc 2021;96:2448-63. DOI: https://doi.org/10.1016/j.mayocp.2021.03.016
  12. Lu L, Wu F, Peng J, et al. Clinical characterization and outcomes of impulse oscillometry-defined bronchodilator response: an ECOPD cohort-based study. Respir Res 2024;25:149. DOI: https://doi.org/10.1186/s12931-024-02765-7
  13. Almeshari MA, Alobaidi NY, Sapey E, et al. Small airways response to bronchodilators in adults with asthma or COPD: a systematic review. Int J Chron Obstruct Pulmon Dis 2021;16:3065-82. DOI: https://doi.org/10.2147/COPD.S331995
  14. Mou T, Wang Y, Fu Y, et al. Analysis of the correlations and inconsistencies between spirometry and impulse oscillometry in the diagnosis of small-airway dysfunction. BMC Pulm Med 2024;24:619. DOI: https://doi.org/10.1186/s12890-024-03420-z
  15. Mas Fazlin MJ, Ching ZH, Azat AA, Mohamed Faisal AH. Correlation between impulse oscillometry with bronchodilator reversibility in asthmatic population in a tertiary referral centre. Med J Malaysia 2024;79:21-7.
  16. Global Initiative for Asthma. Global strategy for asthma management and prevention 2023. Available from: https://ginasthma.org/wp-content/uploads/2024/05/GINA-2023-Report-WMSA.pdf. Accessed on: 29/01/2025.
  17. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of COPD 2023. Available from: https://goldcopd.org/wp-content/uploads/2023/03/GOLD-2023-ver-1.3-17Feb2023_WMV.pdf. Accessed on: 20/01/2025.
  18. Hill AT, Sullivan AL, Chalmers JD, et al. British Thoracic Society Guideline for bronchiectasis in adults. Thorax 2019;74:1-69. DOI: https://doi.org/10.1136/thoraxjnl-2018-212463
  19. Graham BL, Steenbruggen I, Miller MR, et al. Standardization of spirometry 2019 update. An official American Thoracic Society and European Respiratory Society technical statement. Am J Respir Crit Care Med 2019;200:e70-88. DOI: https://doi.org/10.1164/rccm.201908-1590ST
  20. King GG, Bates J, Berger KI, et al. Technical standards for respiratory oscillometry. Eur Respir J 2020;55:1900753. DOI: https://doi.org/10.1183/13993003.00753-2019
  21. Stanojevic S, Kaminsky DA, Miller MR, et al. ERS/ATS technical standard on interpretive strategies for routine lung function tests. Eur Respir J 2022;60:2101499. DOI: https://doi.org/10.1183/13993003.01499-2021
  22. Crim C, Celli B, Edwards LD, et al. Respiratory system impedance with impulse oscillometry in healthy and COPD subjects: ECLIPSE baseline results. Respir Med 2011;105:1069-78. DOI: https://doi.org/10.1016/j.rmed.2011.01.010
  23. Lu L, Peng J, Zhao N, et al. Discordant spirometry and impulse oscillometry assessments in the diagnosis of small airway dysfunction. Front Physiol 2022;13:892448. DOI: https://doi.org/10.3389/fphys.2022.892448
  24. Pisi R, Aiello M, Frizzelli A, et al. Detection of small airway dysfunction in asthmatic patients by spirometry and impulse oscillometry system. Respiration 2023;102:487-94. Erratum in: Respiration 2023;102:861. DOI: https://doi.org/10.1159/000531205
  25. Cottini M, Licini A, Lombardi C, Berti A. Prevalence and features of IOS-defined small airway disease across asthma severities. Respir Med 2021;176:106243. DOI: https://doi.org/10.1016/j.rmed.2020.106243
  26. Gao L, Wang H, Wu Y, et al. Diagnostic value of impulse oscillometry in chronic obstructive pulmonary disease: a multicentre, retrospective, observational study. BMJ Open 2024;14:e087687. DOI: https://doi.org/10.1136/bmjopen-2024-087687
  27. Talwar D, Pahuja S, Prajapat D, et al. Small airway involvement in severe asthma: how common is it and what are its implications? Monaldi Arch Chest Dis 2025;95:3005. DOI: https://doi.org/10.4081/monaldi.2024.3005
  28. Pornsuriyasak P, Khiawwan S, Rattanasiri S, et al. Prevalence of small airways dysfunction in asthma with- and without-fixed airflow obstruction and chronic obstructive pulmonary disease. Asian Pac J Allergy Immunol 2021;39:296-303.
  29. Postma DS, Brightling C, Baldi S, et al. Exploring the relevance and extent of small airways dysfunction in asthma (ATLANTIS): baseline data from a prospective cohort study. Lancet Respir Med 2019;7:402-416. DOI: https://doi.org/10.1016/S2213-2600(19)30049-9
  30. Smith EF, Bradshaw TK, Urs RC, et al. Oscillometry and spirometry are not interchangeable when assessing the bronchodilator response in children and young adults born preterm. Pediatr Pulmonol2023;58:3122-32. DOI: https://doi.org/10.1002/ppul.26632
  31. Sheen YH, Jee HM, Ha EK, et al. Impulse oscillometry and spirometry exhibit different features of lung function in bronchodilation. J Asthma 2018;55:1343-51. DOI: https://doi.org/10.1080/02770903.2017.1418884

Metrics

Citations and online attention from Dimensions, Altmetric and PlumX.

PlumX Metrics

License

Copyright (c) 2026 The Author(s)

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.