Electrical circuit models of the human respiratory system reflect small airway impairment measured by impulse oscillation (IOS)

The use of the forced oscillatory input impedance parameter, frequency-dependence of Resistance (fdR), to assess small airway impairment (SAI) has not been widely accepted due to concern about the effects of “upper airway shunt” on oscillometric resistance and low frequency reactance. On the other hand, recent medical studies suggest that low frequency reactance is a very sensitive index of treatment intervention directed at small airways. The present study was undertaken to analyze and compare Impulse Oscillometry (IOS) resistance and reactance data with model-derived indices of small airway function from two models of the respiratory impedance, one with, and the other without an element for upper airway shunt capacitance. Fifty six patients with stable chronic obstructive lung disease of varying severity due to Cystic Fibrosis (CF) and 21 patients with asthma were evaluated by IOS testing. IOS data were input into the augmented RIC (aRIC) model with an upper airway shunt capacitance, and the extended RIC (eRIC) model, without a shunt capacitance element. Model-derived indices were compared between the two models for CF patients separately from asthma patients. We conclude that IOS indices of SAI are modeled equally well with or without upper airway shunt capacitance, and do not seem to be dependent on upper airway shunt capacitance.