Oscillatory pressure transients after flow interruption during bronchial challenge test in children

The measurement of the conventional interrupter resistance (Rint) is dependent on pressure equilibration between alveolar and airway opening pressure, which is often not achieved in the presence of severe airways obstruction or in small children. The damping properties (d) of postocclusional oscillatory pressure transients after rapid flow interrruption can be assessed independent of complete pressure equilibration, and we have previously shown them to be correlated to resistive properties of the respiratory system. We wanted to determine whether these transients were an expression of acoustic properties of the air in the airways, or whether they were caused by an interaction of gas and lung tissue, and whether d was more sensitive than Rint to changes in airway mechanics. Bronchial challenge tests were carried out with cumulative doses of inhaled carbachol in 10 healthy children (aged 7-14 yrs) and 50 asthmatic children (aged 5-15 yrs). The airflow interruptions were performed with a combined nebulizer-shutter head, allowing resistance measurements with each breath. The frequency, and the damping factor of the postocclusional pressure transients changed significantly during carbachol challenge in both groups of children. The provocation dose (PD) at which the damping factor (d) of the oscillatory pressure transients increased more than 2 SD above the baseline mean ("variance-based", PDvb) was lower than the PDvb of the end-interruption resistance (Rint, EI). These changes in frequency and damping factor were reversible after inhaling salbutamol. These findings suggest that the damping properties of the postocclusional pressure transients after flow interruption can be used as a sensitive parameter to assess changes in airway mechanics during bronchial challenge test in children in whom pressure equilibration is frequently not achieved during airflow interruption due to airways obstruction.

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