Impulse oscillometry (IOS) is a variant of forced oscillation technique described by Dubois 50 years ago, which allows us to measure the reactance of the airways and the resistance of the small and large airways during tidal breathing. It requires minimal patient cooperation from subjects who are unable to perform spirometry, like elders, children and patients with neurologic disorders. IOS can outline the diagnosis of obstructive airway disease, differentiate small airway obstruction from large airway obstruction. It is more sensitive than spirometry for peripheral airway disease in determining the severity of the disease, the exacerbations and evaluate the therapeutic response. Other applications include early evaluation of transplant rejection, cystic fibrosis, vocal cord disorder, bronchiectasis, hypersensitivity pneumonitis, obstructive sleep apnea.
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1. Desiraju K, Agrawal A. Impulse oscillometry: The state-of-art for lung function testing. Lung India. 2016; 33(4): 410–416.
2. Su ZQ, Guan WJ, Li SY, Ding M, Chen Y, Jiang M et al. Significances of spirometry and impulse oscillometry for detecting small airway disorders assessed with endobronchial optical coherence tomography in COPD. Int J Chron Obstruct Pulmon Dis. 2018;13:3031-3044.
3. Dubois AB, Botelho SY, Comroe JH. A new method for measuring airway resistance in man using a body plethysmograph: Values in normal subjects and in patients with respiratory disease. J Clin Invest. 1956; 35: 327–35.
4. Hogg JC, Chu F, Utokaparch S, Woods R, Elliott WM, Buzatu L, et al. The nature of small-airway obstruction in chronic obstructive pulmonary disease. N Engl J Med. 2004; 350: 2645–2653.
5. Contoli M, Bousquet J, Fabbri LM, Magnussen H, Rabe KF, Siafakas NM, et al. The small airways and distal lung compartment in asthma and COPD: A time for reappraisal. Allergy. 2010; 65:141–51.
6. Smith HJ, Reinhold P, Goldman MD. Forced oscillation technique and impulse oscillometry. European Respiratory Monograph. Ch. 5. In: Gosselink R, Stam H, editors. Lung Function Testing. UK: European Respiratory Society Publications; 2005; 72–105.
7. Bickel S, Popler J, Lesnick B, Eid N. Impulse oscillometry: Interpretation and practical applications. Chest. 2014; 146: 841–847.
8. Oostveen E, MacLeod D, Lorino H, Farre R, Hantos Z, Desager K, et al. The forced oscillation technique in clinical practice: methodology, recommendations and future developments. Eur Respir J. 2003; 22: 1026-41.
9. Hogg JC, Williams J, Richardson JB, Macklem PT, Thurlbeck WM. Age as a factor in the distribution of lower-airway conductance and in the pathologic anatomy of obstructive lung disease. N Engl J Med. 1970; 282:1283–1287.
10. Mead J. The lung’s “quiet zone” N Engl J Med. 1970; 282:1318–1319.
11. Shiota S, Katoh M, Fujii M, Aoki S, Matsuoka R, Fukuchi Y. Predictive equations and the reliability of the impulse oscillatory system in Japanese adult subjects. Respirology. 2005; 10: 310–315.
12. Newbury W, Crockett A, Newbury J. A pilot study to evaluate Australian predictive equations for the impulse oscillometry system. Respirology. 2008; 13:1070–5.
13. Song TW, Kim KW, Kim ES, Park JW, Sohn MH, Kim KE. Utility of impulse oscillometry in young children with asthma. Pediatr Allergy Immunol. 2008;19:763–768.
14. Marotta A, Klinnert MD, Price MR, Larsen GL, Liu AH. Impulse oscillometry provides an effective measure of lung dysfunction in 4-year-old children at risk for persistent asthma. J Allergy Clin Immunol. 2003;112:317–322.
15. Kim HY, Shin YH, Jung da W, Jee HM, Park HW, Han MY. Resistance and reactance in oscillation lung function reflect basal lung function and bronchial hyperresponsiveness respectively. Respirology. 2009; 14(7):1035-1041.
16. Qi GS, Zhou ZC, Gu WC, Xi F, Wu H, Yang WL, et al. Detection of the airway obstruction stage in asthma using impulse oscillometry system. J Asthma. 2013; 50(1): 45–51.
17. Shi Y, Aledia AS, Galant SP, George SC. Peripheral airway impairment measured by oscillometry predicts loss of asthma control in children. J Allergy Clin Immunol. 2013;131:718–723.
18. Gonem S, Umar I, Burke D, Desai D, Corkill S, Owers-Bradley J, et al. Airway impedance entropy and exacerbations in severe asthma. Eur Respir J. 2012;40:1156–1163.
19. Bailly C, Crenesse D, Albertini M. Evaluation of impulse oscillometry during bronchial challenge testing in children. Pediatr Pulmonol. 2011;46:1209–1214.
20. Schulze J, Smith HJ, Fuchs J, Herrmann E, Dressler M, Rose MA, et al. Methacholine challenge in young children as evaluated by spirometry and impulse oscillometry. Respir Med. 2012;106:627–634.
21. Asseri A, Debra Stern Stefano Guerra Anne Wright Fernando Martinez; and Wayne Morgan University of Arizona, Tucson, AZ, Impulse Oscillometry Compared to Spirometry in Adults With a History of Bronchitis, Chest 2016;150(4, suppl):1113A
22. Arikoglua T, Batmaz SB, Yildirim DD, Tezol Ö, Bozlu G, Kuyucu S. Asthma predictive index in relation to respiratory mechanics by impulse oscillometry in recurrent wheezers, Allergol Immunopathol (Madr). 2018;46(2):190-195.
23. Gong SG, Yang WL, Zheng W, Liu JM. Evaluation of respiratory impedance in patients with chronic obstructive pulmonary disease by an impulse oscillation system. Mol Med Rep. 2014;10:2694–7200.
24. Frantz S, Nihlén U, Dencker M, Engström G, Löfdahl CG, Wollmer P. Impulse oscillometry may be of value in detecting early manifestations of COPD. Respir Med. 2012;106:1116–1123.
25. Komarow HD, Myles IA, Uzzaman A, Metcalfe DD. Impulse oscillometry in the evaluation of diseases of the airways in children. Ann Allergy Asthma Immunol. 2011;106:191-199
26. Crim C, Celli B, Edwards LD, Wouters E, Coxson HO, Tal-Singer R, et al. Respiratory system impedance with impulse oscillometry in healthy and COPD subjects: ECLIPSE baseline results. Respir Med. 2011;105:1069–78.
27. Shinke H, Yamamoto M, Hazeki N, Kotani Y, Kobayashi K, Nishimura Y. Visualized changes in respiratory resistance and reactance along a time axis in smokers: A cross-sectional study. Respir Investig. 2013;51:166–74.
28. Manoharan AW, Lipworth J, Ibrahim I, Lipworth B. Small Airways Dysfucntion Is Associated with Poorer Control in Asthmatic Patients with a Preserved FEV1 Chest 2014;44(suppl 58);3406
29. Mineshita M, Shikama Y, Nakajima H, Nishihira R, Komatsu M, Kunota M, et. al. The application of impulse oscillation system for the evaluation of treatment effects in patients with COPD. Respiratory Physiology and Neurobiology, 2014; 202:1-5.
30. Sakarya A, Uyan ZS, Baydemir C, Anik Y, Erdem E, Gokdemir Y, et al. Evaluation of children with cystic fibrosis by impulse oscillometry when stable and at exacerbation. Pediatr Pneumol. 2016;51(11):1151-1158.
31. Kaltreider HB. Hypersensitivity Pneumonitis. West J. Med. 1993;159:570-578.
32. Guerrero Zúñiga S, Sánchez Hernández J, Mateos Toledo H, Mejía Ávila M, Gochicoa-Rangel L, Miguel Reyes JL, et al. Small airway dysfunction in chronic hypersensitivity pneumonitis. Respirology. 2017;22(8):1637-1642.
33. Ochman M, Wojarski J, Wiórek A, Slezak W, Maruszewski M, Karolak W, et al. Usefulness of the impulse oscillometry system in graft function monitoring in lung transplant recipients. Transplantation Proceedings. 2018;50(7):2070-2074.
34. Barker AF. Bronchiectasis. N Engl J Med 2002;346:1383–1393.
35. Guan WJ, Gao YH, Xu G, Lin ZY, Tang Y, Li HM, et al. Impulse Oscillometry in Adults with Bronchiectasis. Ann Am Thorac Soc. 2015:12(5):657-667
36. Abdeyrim A, Li N, Shao L, Heizhati M, Wang Y, Yao X, et al. What can impulse oscillometry and pulmonary function testing tell us about obstructive sleep apnea: a case-control observational study? Sleep Breath. 2016;20(1):61-68.
37. Huiguo L, Wang N, Jianping Z, Shengdao X, Yongjian X, Zhenxiang Z. The diagnosis value and its implication of impulse oscillometry in obstructive sleep apnea syndrome patients. J Tongji Med Univ. 2000;20(4):280-282.
38. Verbanck S, de Keukeleire T, Schuermans D, Meysman M, Vincken W, Thompson B. Detecting upper airway obstruction in patients with tracheal stenosis. J Appl Physiol (1985). 2010;109(1):47-52.
39. Komarow HD, Young M, Nelson C, Metcalfe DD. Vocal cord dysfunction as demonstrated by impulse oscillometry. J Allergy Clin Immunol Pract. 2013;1(4):387-393.
40. van Noord JA, Clément J, Cauberghs M, Mertens I, Van de Woestijne KP, Demedts M. Total respiratory resistance and reactance in patients with diffuse interstitial lung disease. Eur Respir J. 1989;2(9):846-852.
41. Morris MJ, Dodson DW, Lucero PF, et al. Study of active duty military for pulmonary disease related to environmental deployment exposures (STAMPEDE). Am J Respir Crit Care Med. 2014;190(1):77-84.
42. Mauer MP, Cummings KR. Impulse oscillometry and respiratory symptoms in World Trade Center responders, 6 years post-9/11. Lung. 2010;188(2):107-113.
43. Bednarek M, Grabicki M, Piorunek T, Batura-Gabryel H. Current place of impulse oscillometry in the assessment of pulmonary diseases. Respir Med. 2020;170: 105952.