Bronchodilator Responsiveness Assessed by Forced Oscillometry and Multiple Breath Washout Techniques in Preschool Children

Importance: The forced oscillation (FOT) and multiple breath washout (MBW) techniques are passive tests of lung function, and are reliable for preschool-age children. There has not been comparison testing to determine which test could more accurately differentiate between healthy controls and poorly controlled asthmatics, or differentiate a response to bronchodilator administration.

Objective: To determine whether the MBW and/or FOT could differentiate between healthy controls and poorly controlled asthmatics, and whether the two tests could detect a response to bronchodilator administration.

Methods: Twenty-eight healthy controls and 23 poorly controlled asthmatics 3-6 years of age participated. All subjects were administered the MBW followed by the FOT. A bronchodilator was then administered and testing was repeated. Wilcoxon Rank Sum tests were used to compare the difference between healthy controls and poorly controlled asthmatics. Wilcoxon Signed Rank tests were used to compare the pre- and post-bronchodilator values.

Results: Neither MBW nor FOT differentiated healthy controls from poorly controlled asthmatics (pre-bronchodilator data); both groups had similar baseline gas mixing and airway mechanics. There was no improvement in any MBW outcomes post-bronchodilator administration. FOT detected a significant and similar degree of improvement in the airway mechanics in both groups.

Interpretation: Neither MBW nor FOT differentiated between poorly controlled asthmatics (when well) and healthy controls. MBW did not detect a significant bronchodilator response in either subject group, whereas FOT detected a similar degree of bronchodilator responsiveness in both groups. This discrepancy may reflect differential changes in airway mechanics and gas mixing properties in response to bronchodilators.