Zusammenfassung
Die Impulsoszillometrie (IOS) ist eine computergestützte
Methode zur Messung komplexer mechanischer Eigenschaften der Atemwege. Ziel
dieser Studie war die IOS in der Diagnose obstruktiver Atemwegserkrankungen im
Hinblick auf die praktische Anwendbarkeit vergleichend zu den Standardverfahren
Spirometrie, Pneumotachygrafie und Bodyplethysmografie zu evaluieren.
Retrospektiv wurden 244 Patienten (Alter
61,5 ± 13,6 J; 61 % männlich)
mit Asthma bronchiale (n = 65) und chronisch obstruktiver
Lungenerkrankung (chronic obstructive pulmonary disease, COPD)
(n = 179) untersucht. Mittels Bodyplethysmografie (SRtot
> 120 %SW) wurde bei 94 % der Patienten
eine Obstruktion diagnostiziert, mittels Pneumotachografie (FEV1
< 80 %SW) bei 78 % und mittels IOS je
nach Parameter bei 87 – 94 %. Leicht- und
mittelgradige Obstruktionen wurden durch alle IOS-Parameter außer R20
erfasst, schwere Obstruktionen jedoch besser durch die
Frequenzabhängigkeit der Resistance FDR und die Reactance bei 5 Hz
X5. Die Parameter R5, X5 und Zrs zeigten jedoch eine Tendenz zur
Unterschätzung des Obstruktionsgrades. Eine bronchiale Obstruktion kann
durch die IOS insgesamt sicher diagnostiziert werden, sofern bei schwerer
Obstruktion komplexe IOS-Parameter wie FDR und X5 mit einbezogen werden. Die
Parameter der Standardverfahren (Bodyplethysmografie und Pneumotachografie)
zeigten aufgrund unterschiedlicher Messprinzipien insgesamt geringe
statistische Korrelationen sowohl zur IOS, als auch im Vergleich untereinander.
Zusammenfassend ist die IOS nach den Ergebnissen der Untersuchung eine
patientenschonende und wenig kooperationsabhängige Methode zur Evaluierung
obstruktiver Atemwegserkrankungen, welche bisherige Standardmethoden sinnvoll
ergänzt und sich darüber hinaus als sensitives Screeninginstrument
zur frühzeitigen Erkennung einer Bronchialobstruktion eignet.
Abstract
Impulse oscillometry (IOS) is a computer-supported method for the
measurement of complex mechanical airway characteristics. The aim of this study
was to evaluate the applicability of IOS in the diagnosis of obstructive airway
diseases in comparison to the standard methods of spirometry, pneumotachymetry,
and bodyplethysmography. 244 patients (age 61.5 ± 13.6
years; 61 % men) with bronchial asthma
(n = 65) and chronic obstructive pulmonary disease (COPD)
(n = 179) were retrospectively analysed. By means of body
plethysmography (Srtot < 120 %pred) an obstruction was
diagnosed in 94 %, by pneumotachymetry (FEV1
< 80 %pred) in 78 %, and by IOS depending
on the parameter chosen in 87 – 94 % of
patients. Mild and medium obstructions could be identified by means of all IOS
parameters except for R20: severe obstructions, however, were better detected
by means of the frequency-dependant resistance FDR and reactance at
5 Hz, X5. The parameters R5, X5, and Zrs, however, showed a tendency to
underestimate the degree of obstruction. Bronchial obstruction can reliably be
diagnosed by IOS when, in cases of severe obstruction, more complex parameters
like FDR and X5 are included. The parameters of the standard methods (body
plethysmography and pneumotachymetry) show relatively low correlations due to
the different measurement methods not only in comparison to IOS but also to one
another. In summary, IOS is a convenient method for patients with a low
dependency on cooperation for the evaluation of obstructive airway diseases
complementary to the established standard methods and, in addition, is useful
as a sensitive screening tool for the early detection of bronchial
obstruction.
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1 Jörg Winkler und Anne Hagert-Winkler haben zu gleichen Teilen
zu der Arbeit beigetragen.
2 Teile der Arbeit sind Gegenstand der Dissertationsschrift von Anne
Hagert-Winkler.
3 Herrn Professor Schauer, unserem klinischen Lehrer, zum 70.
Geburtstag gewidmet.
Dr. med. Jörg Winkler
Fachpraxis für Pneumologie und Allergologie
Kreuzstr. 2a 04103 Leipzig
Email: lungewinkler@aol.com