Measuring Oscillometry During Recovery After Emergency Department Treatment for Asthma Exacerbations in Children

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Abstract Rationale: Recovery after pediatric emergency department (ED) treatment for acute asthma exacerbations is poorly understood. Oscillometry is a safe and effort-independent method to measure respiratory system resistance and compliance in both the ED and outpatient follow-up settings to objectively evaluate lung function recovery. The objective of this pilot study was to evaluate participant-reported symptoms and oscillometry during acute exacerbations in the ED and 7 days post-visit. Methods: Prospective study of children aged 2-18 years treated for acute asthma exacerbations in the ED. Participants completed a 17-item asthma flare-up symptom diary scored on a 1-7 scale (7=worst) in the ED and at a follow-up visit 7 days later; a change in average score ±0.55 has been deemed clinically relevant in prior literature. The Tremoflo c-100 was used to obtain oscillometry measurements at 7-41Hz after asthma treatments during the ED visit, and again at the follow-up visit. Resistance at 7Hz (R7) and area of reactance (AX) were transformed to z-scores using height-based reference equations. Descriptive statistics are reported as median (IQR). Results: Of 20 participants enrolled, median age was 7.71 (5.5, 12.2) years, 75% were male, 25% were Black/African American, 70% were publicly insured, and 45% had an asthma controller prescription. There was a clinically relevant improvement in symptom scores for all participants: the median difference between the ED visit and day 7 follow-up visit was -2.12 (-2.71, -1.02). There were 14 participants with successful oscillometry at both timepoints. The figure shows R7 and AX measured in the ED and at day 7, stratified by children with improvement (decreases) in both R7 and AX (n=6) and children without improvement (increases) in R7 and/or AX (n=8) between the visits. Among those with lung function improvement, R7 z-score decreased by -1.11 (-1.87, -0.52) and AX z-score decreased by -1.52 (-2.74, -0.57). Among those without improvement, R7 z-score increased by 0.80 (0.51, 1.45) and AX z-score increased by 0.06 (-0.03, 0.78). Conclusions: This pilot study shows variability in lung function after ED treatment for acute asthma exacerbations and in the subsequent recovery period. Oscillometry may be an important tool to objectively assess exacerbation resolution and recovery. Future studies are needed to determine associations between oscillometry measurements and clinical asthma outcomes.

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