Search

Recently, "Technical standards for respiratory oscillometry" was published, which reviewed the physiological basis of oscillometric measures and detailed the technical factors related to equipment and test performance, quality assurance and reporting of results. Here we present a review of the clinical significance and applications of oscillometry. We briefly review the physiological principles of oscillometry and the basics of oscillometry interpretation, and then describe what is currently known about oscillometry in its role as a sensitive measure of airway resistance, bronchodilator responsiveness and bronchial challenge testing, and response to medical therapy, particularly in asthma and COPD. The technique may have unique advantages in situations where spirometry and other lung function tests are not suitable, such as in infants, neuromuscular disease, sleep apnoea and critical care. Other potential applications include detection of bronchiolitis obliterans, vocal cord dysfunction and the effects of environmental exposures. However, despite great promise as a useful clinical tool, we identify a number of areas in which more evidence of clinical utility is needed before oscillometry becomes routinely used for diagnosing or monitoring respiratory disease., Competing Interests: Conflict of interest: D.A. Kaminsky reports personal payments made as faculty speaker for Cardiorespiratory Diagnostics Seminar from MGC Diagnostics, Inc. outside the submitted work. Past Chair of ATS Proficiency Standards for Pulmonary Function Laboratories Committee, unpaid. Conflict of interest: S.J. Simpson has nothing to disclose. Conflict of interest: K.I. Berger has nothing to disclose. Conflict of interest: P. Calverley reports receiving consulting fees paid by Phillips Respironics for advisory work on a novel COPD ventilator. Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events received from Phillips Respironics, outside the submitted work. Conflict of interest: P.L. de Melo reports patent 28727 issued. Conflict of interest: R.J. Dandurand reports grants or contracts paid to the institution from AstraZeneca, Boehringer-Ingelheim, Covis Pharma, Grifols, MGC Diagnostics, Teva Pharma, Thorasys, and Vyaire, outside the submitted work. Speaking payment from Novartis for L'oscillométrie en clinique: qu'ajoute-t-elle aux évaluations pulmonaires?, 18 September 2019, Boehringer-Ingelheim for L'oscillométrie: vieille physiologie avec un avenir brilliant, 17 November 2020, and Latin American Respiratory Physiology Society for Oscillometry in Asthma and COPD: Interpretation Strategies, 14 November 2020, outside the submitted work. Chairman, Oscillometry Harmonisation Study Group, an international committee academic and industry experts working to standardise oscillometry devices, and Chairman, Respiratory Effectiveness Group Technologies Working Group, Cambridge, U.K. (https://www.regresearchnetwork.org). Conflict of interest: R.L. Dellacà reports royalties or licenses from Restech, Philips and Vyaire. Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events received from Restech and Philips, outside the submitted work. Support for attending meetings from Philips and Vyaire. Patent issued, owned and licensed from Politecnico di Milano University. Member of the Board of Directors for Restech. Stocks owned for Restech. Free loan of equipment for studies received from Vyaire and Restech. Conflict of interest: C.S. Farah has nothing to disclose. Conflict of interest: R. Farré has nothing to disclose. Conflict of interest: G.L. Hall has nothing to disclose. Conflict of interest: I. Ioan has nothing to disclose. Conflict of interest: C.G. Irvin received consulting fees from Medical Graphics Corporation, outside the submitted work. Conflict of interest: D.W. Kaczka reports support for the present manuscript from University of Iowa. Grants or contracts from Dept of Defence and NIH, outside the submitted work. Consulting fees received from ZOLL Medical, Inc. Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events received from CHEST, ASME, Medical Society of New Zealand, and Johns Hopkins University, outside the submitted work. US patent 10,675,423 B2 (patent on MFOV technique, inventor) and PCT patent pending, patent on MFOV technique pending. Stock or stock options held for OscillaVent, Inc. Loan of ventilator for other projects from ZOLL Medical Inc. Conflict of interest: G.G. King reports grants or contracts from Restech Italy, NHMRC, Boehringer Ingelheim, CycloPharm, GlaxoSmithKline, Menarini, MundiPharma, Philanthropic individuals and societies, outside the submitted work. Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events received from AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, CycloPharm, GlaxoSmithKline, Menarini, MundiPharma and Novartis, outside the submitted work. Leadership or fiduciary role in other board, society, committee or advocacy group for ERS Technical Standards for Respiratory Oscillometry. Conflict of interest: H. Kurosawa reports receiving a grant from CHEST Co. Ltd. Royalties or licence for CHEST Co. Ltd. Payment or honoraria for lectures received from CHEST Co. Ltd. Nippon, Boehringer Ingelheim, Novartis, and Teijin Pharma, outside the submitted work. Conflict of interest: E. Lombardi reports grants or contracts from Restech and Sanofi, outside the submitted work. Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events received from Angelini, Chiesi, GSK, Novartis and Sanofi, outside the submitted work. Participation on a Data Safety Monitoring Board or Advisory Board for GSK and Novartis. Conflict of interest: G.N. Maksym reports grants or contracts from National Research Council of Canada, Cyclomedica Inc. Australia, and Lung Association of Nova Scotia, outside the submitted work. Accommodation Expenses received from Thorasys, Thoracic Medical Systems Inc. for attending European Society Meeting 2019. Patents planned, issued or pending for Method and system to acquire oscillometry measurements, owned by Thorasys, Thoracic Medical Systems Inc. Stock or stock options held for Thorasys, Thoracic Medical Systems Inc. Conflict of interest: F. Marchal has nothing to disclose. Conflict of interest: E. Oostveen has nothing to disclose. Conflict of interest: B.W. Oppenheimer has nothing to disclose. Conflict of interest: P.D. Robinson has nothing to disclose. Conflict of interest: M. van den Berge reports grants or contracts from GlaxoSmithKline, Novartis, Astra Zeneca, Roche, and Genentech, outside the submitted work. Conflict of interest: C. Thamrin report grants or contracts from Restech SRL and THORASYS Thoracic. Equipment on loan for research studies from Restech SRL and THORASYS Thoracic, outside the submitted work., (Copyright ©The authors 2022.)

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., Competing Interests: Conflict of interest: G.G. King reports grants from American Thoracic Society and European Respiratory Society, during the conduct of the study; a collaborative research agreement and IP agreement with Restech, grants and personal fees for lectures from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Menarini, MundiPharma and Cyclomedica, grants from NH&MRC, Philanthropic Societies, Sydney University, outside the submitted work. Conflict of interest: J. Bates is a minor shareholder and received personal fees for advisory board work from Oscillavent, LLC, outside the submitted work; and has a patent (patent application US 20160007882 A1; proposes the use of oscillometry in ventilated patients) pending to none, and a patent PCT application WO2015127377 A1 (proposes variable tidal volume ventilation as a means of performing oscillometry in ventilated patients) pending to none. Conflict of interest: K.I. Berger has nothing to disclose. Conflict of interest: P. Calverley has advised Philips Respironics about the clinical application of FOT and spoken on this topic at meetings supported by this company. Conflict of interest: P.L. de Melo has a patent 28727 issued. Conflict of interest: R.L. Dellacà has a patent on the detection of EFL by FOT with royalties paid to Philips Respironics and Restech srl, a patent on monitoring lung volume recruitment by FOT with royalties paid to Vyaire, and a patent on early detection of exacerbations by home monitoring of FOT with royalties paid to Restech, and is co-founder and shareholder of Restech srl, a spin-off company of the Politecnico di Milano University producing medical devices for lung function testing based on FOT. Conflict of interest: R. Farré reports contracts for bench assessment of CPAP devices from Resmed and ANTADIR, outside the submitted work. Conflict of interest: G.L. Hall reports grants from American Thoracic Society and European Respiratory Society, during the conduct of the study. Conflict of interest: I. Ioan has nothing to disclose. Conflict of interest: C.G. Irvin reports other for advisory board work from Methapharm, personal fees and non-financial support for advisory board work from Medical Graphics Corp, grants from NIH and American Lung Association, outside the submitted work. Conflict of interest: D.W. Kaczka reports grants from US Department of Defense (W81XWH-16-1-0434) and National Institutes of Health (R01-HL112986, R01-HL126838 and R41-HL140640), and is co-founder and shareholder from OscillaVent, Inc., during the conduct of the study; grants from ZOLL Medical Corporation, and is shareholder and member of an advisory board for Monitor Mask, Inc., outside the submitted work; and has a patent Systems and methods for multi-frequency oscillator ventilation pending to OscillaVent, Inc. (US20160339191A1), a patent Treatment of respiratory condition using targeted delivery pending (US20150290418A1), a patent System and method for setting positive end expiratory pressure during mechanical ventilation based on dynamic lung function (US20070240717A1, abandoned), a patent Enhanced ventilation waveform device issued (US 6,435,182 B1), and a patent Servo-controlled pneumatic pressure oscillator for respiratory impedance measurements and high-frequency ventilation (US20070006924A1, abandoned). Conflict of interest: D.A. Kaminsky reports personal fees for lectures from MGC Diagnostics, Inc., outside the submitted work. Conflict of interest: H. Kurosawa reports grants and personal fees from Chest M.I. Inc., during the conduct of the study; personal fees from Nippon Boehringer Ingelheim Co. Ltd, outside the submitted work; and has a patent US2012101400 with royalties paid to Tohoku University. Conflict of interest: E. Lombardi reports personal fees from Angelini, Boehringer, GSK, Omron and Vifor, grants and personal fees from Chiesi, Lusofarmaco and Novartis, grants and non-financial support from ResTech, personal fees and non-financial support from Vertex, outside the submitted work. Conflict of interest: G.N. Maksym reports financial support from Thorasys, Thoracic Medical Systems Inc, prior to the submitted work and non-financial support from Thorasys during the submitted work; and has a patent Respiratory Device (design patent) issued to Thorasys, a patent Respiratory Device filter issued to Thorasys, a patent Piezoelectric beam bending actuated Device for measuring respiratory system impedance issued to Thorasys, and a patent Method of assessment of airway variability in airway hyperresponsiveness issued to Thorasys. Conflict of interest: F. Marchal has nothing to disclose. Conflict of interest: B.W. Oppenheimer has nothing to disclose. Conflict of interest: S.J. Simpson has nothing to disclose. Conflict of interest: C. Thamrin has a patent WO 2006130922 A1 issued which is broadly relevant to the work, and has intellectual property arrangements with Thorasys Medical Systems and Restech srl relating to research collaborations, but does not have any financial relationships with either company. Conflict of interest: M. van den Berge reports grants paid to the university from AstraZeneca, TEVA, GSK and Chiesi, outside the submitted work. Conflict of interest: E. Oostveen has nothing to disclose., (Copyright ©ERS 2020.)

This review addresses how the combination of physiology, medicine and engineering principles contributed to the development and advancement of mechanical ventilation, emphasising the most urgent needs for improvement and the most promising directions of future development. Several aspects of mechanical ventilation are introduced, highlighting on one side the importance of interdisciplinary research for further development and, on the other, the importance of training physicians sufficiently on the technological aspects of modern devices to exploit properly the great complexity and potentials of this treatment., Educational Aims: To learn how mechanical ventilation developed in recent decades and to provide a better understanding of the actual technology and practice.To learn how and why interdisciplinary research and competences are necessary for providing the best ventilation treatment to patients.To understand which are the most relevant technical limitations in modern mechanical ventilators that can affect their performance in delivery of the treatment.To better understand and classify ventilation modes.To learn the classification, benefits, drawbacks and future perspectives of automatic ventilation tailoring algorithms., Competing Interests: Conflict of interest Disclosures can be found alongside this article at breathe.ersjournals.com