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Table 1. Mean ⫾ SD for Height, Weight, and Body Mass Index of the Children and Adolescents, Stratified by Sex and Age
Boys Girls
Age, y
n Height, cm Weight, kg BMI (TS), kg/m2 n Height, cm Weight, kg BMI (TS), kg/m2
6 8 121.2 ⫾ 7.8 23.4 ⫾ 3.9 15.7 ⫾ 1.0 7 116.8 ⫾ 4.4 21.1 ⫾ 3.2 15.2 ⫾ 1.4
7 5 123.9 ⫾ 3.6 24.9 ⫾ 2.7 16.2 ⫾ 1.7 5 127.2 ⫾ 2.8 26.4 ⫾ 1.7 16.3 ⫾ 1.5
8 5 129.5 ⫾ 3.0 26.7 ⫾ 3.2 15.9 ⫾ 1.3 5 130.3 ⫾ 9.4 27.1 ⫾ 4.5 15.9 ⫾ 2.2
9 6 132.9 ⫾ 9.6 30.1 ⫾ 7.0 16.8 ⫾ 1.9 8 136.4 ⫾ 8.2 34.0 ⫾ 6.3 18.1 ⫾ 2.0
10 10 141.7 ⫾ 5.3 35.0 ⫾ 6.6 17.3 ⫾ 2.3 10 147.6 ⫾ 8.2 38.9 ⫾ 7.5 17.7 ⫾ 2.2
11 7 148.5 ⫾ 5.7 40.9 ⫾ 8.4 18.4 ⫾ 2.8 7 143.6 ⫾ 5.0 45.2 ⫾ 7.1 18.9 ⫾ 2.1
12 9 152.6 ⫾ 7.9 45.9 ⫾ 9.8 19.6 ⫾ 2.8 9 149.6 ⫾ 7.6 42.9 ⫾ 4.2 19.1 ⫾ 2.4
13 7 162.3 ⫾ 8.1 49.7 ⫾ 7.8 19.0 ⫾ 2.0 7 161.3 ⫾ 6.0 49.4 ⫾ 5.3 18.9 ⫾ 1.9
14 4 167.3 ⫾ 14.1 57.3 ⫾ 13.9 19.9 ⫾ 2.4 4 161.1 ⫾ 2.8 48.8 ⫾ 6.6 18.9 ⫾ 2.3
Total (123) 61 142.2 ⫾ 16.1* 36.9 ⫾ 12.5* 17.7 ⫾ 2.5* 62 142.8 ⫾ 15.9* 37.2 ⫾ 10.9* 17.7 ⫾ 2.3*
* No significant difference was found between height, weight, and body mass index between sexes (P ⫽ .84, .88, and .98, respectively).
n ⫽ number of participants
BMI (TS) ⫽ body mass index according to the classification from Telessaúde.20
Table 2. Mean ⫾ SD for FEV1, FVC, and FEV1/FVC of Children and Adolescents, Stratified by Sex and Age
Boys Girls
Age, y
FEV1, %* FVC, %* FEV1/FVC FEV1, %* FVC, %* FEV1/FVC
6 99.7 ⫾ 15.9 94.8 ⫾ 12.0 0.9 ⫾ 0.39 99.6 ⫾ 9.7 101.3 ⫾ 14.3 0.9 ⫾ 0.06
7 99.3 ⫾ 10.2 101.8 ⫾ 11.5 0.8 ⫾ 0.10 94.5 ⫾ 10.7 98.4 ⫾ 14.5 0.8 ⫾ 0.03
8 97.6 ⫾ 7.8 97.3 ⫾ 14.7 0.9 ⫾ 0.07 95.5 ⫾ 7.1 100.8 ⫾ 9.9 0.8 ⫾ 0.03
9 102.2 ⫾ 10.0 104.8 ⫾ 10.5 0.8 ⫾ 0.02 93.8 ⫾ 11.2 100.1 ⫾ 7.8 0.8 ⫾ 0.04
10 98.0 ⫾ 9.3 101.4 ⫾ 7.0 0.8 ⫾ 0.03 93.3 ⫾ 9.7 97.7 ⫾ 8.7 0.9 ⫾ 0.04
11 96.4 ⫾ 4.9 101.8 ⫾ 4.4 0.8 ⫾ 0.05 93.7 ⫾ 13.7 98.4 ⫾ 12.2 0.9 ⫾ 0.05
12 96.4 ⫾ 10.1 97.9 ⫾ 9.7 0.8 ⫾ 0.06 96.6 ⫾ 8.6 104.2 ⫾ 6.8 0.8 ⫾ 0.05
13 98.7 ⫾ 8.2 104.2 ⫾ 6.8 0.8 ⫾ 0.05 92.4 ⫾ 8.2 98.5 ⫾ 8.7 0.8 ⫾ 0.06
14 99.5 ⫾ 18.4 108.4 ⫾ 11.8 0.8 ⫾ 0.06 89.1 ⫾ 5.5 96.7 ⫾ 12.7 0.8 ⫾ 0.10
Total 98.6 ⫾ 10.1 101.1 ⫾ 9.8 0.8 ⫾ 0.05 94.6 ⫾ 9.5 99.8 ⫾ 10.4 0.8 ⫾ 0.05
* Percent-of-predicted.
We also excluded 39 children and adolescents who shown in Table 2. Correlations were found between de-
could not be paired for the statistical analysis in order to pendent oscillometry variables and predictor variables, as
decrease selectivity bias and to make the sample as described in Table 3.
homogeneous as possible. 78% of the selected children The results of the Pearson correlation between oscillo-
were classified as normal-weight, and 94.3% were iden- metric parameters (R5, R20, X5, Z5, Fres, and AX) and
tified as white. Boys were age 10.0 ⫾ 2.4 y on average, the anthropometric data show that the variable height had
and girls were age 9.9 ⫾ 2.4 y (P ⫽. 94). Biometric the highest coefficients, ranging from 0.39 to 0.79 in boys
characteristics of height, weight, and body mass index and from 0.74 to 0.77 in girls. There were no differences
are presented in Table 1.The mean body surface areas were between the sexes in the oscillometric variables studied
1.20 ⫾ 0.26 and 1.21 ⫾ 0.24 m2 (P ⫽. 83) for boys and girls, (Table 4). Association of selected impulse oscillometry
respectively. parameters with height and age is presented in Figure 2.
According to the inclusion criteria, all participants had Table 5 presents the models of equations obtained by
ISAAC16 scores below the cutoff point, with mean scores multiple linear regression analysis, according to the sex of
of 0.61 ⫾ 1.06 and 0.74 ⫾ 1.25 in the asthma component the participants (boys and girls). Height was the variable
and 0.39 ⫾ 0.75 and 0.46 ⫾ 0.72 in the rhinitis component with the most predictive power for models of all oscillo-
for boys and girls, respectively. All schoolchildren showed metric variables in boys and for most of the variables in
spirometry values within regular range. Mean values are girls, with the highest coefficients of determination (R2).
Fig. 2. Association of selected impulse oscillometry parameters with height and age. R5 ⫽ resistance at 5 Hz, R20 ⫽ resistance at 20 Hz,
X5 ⫽ reactance at 5 Hz, Fres ⫽ resonant frequency.
Table 5. Respiratory System Reference Equations Obtained by the Impulse Oscillometry System for Boys and Girls
Boys
R5 (kPa/L/s) ⫽ 1.699 ⫺ (0.008 ⫻ height) 62 61 0.099
R20 (kPa/L/s) ⫽ 1.226 ⫺ (0.005 ⫻ height) 49 47 0.089
X5 (kPa/L/s) ⫽ ⫺0.552 ⫹ (0.003 ⫻ height) 15.9 14.4 0.108
Z5 (kPa/L/s) ⫽ 1.802 ⫺ (0.010 ⫻ height) 51 50 0.136
Fres (Hz) ⫽ 44.473 ⫺ (0.195 ⫻ height) 50.5 49.7 3.143
Log AX (kPa/L) ⫽ 0.332 ⫺ (0.002 ⫻ height) 58 57 0.024
Girls
Log R5 (kPa/L/s) ⫽ 0.639 ⫺ (0.006 ⫻ height) 57.5 56.8 0.088
Log R20 (kPa/L/s) ⫽ 0.378 ⫺ (0.005 ⫻ height) 59.1 58.4 0.069
X5 (kPa/L/s) ⫽ ⫺0.586 ⫹ (0.003 ⫻ height) 55.1 54.1 0.043
Log Z5 (kPa/L/s) ⫽ 0.679 ⫺ (0.007 ⫻ height) 59.9 59.2 0.086
Log Fres (Hz) ⫽ 1.555 ⫺ (0.037 ⫻ age) 41.1 40.1 0.109
Log AX (kPa/L) ⫽ 0.892 ⫺ (0.106 ⫻ age) 49.7 48.8 0.265
Based on the highest adjusted R2 values, height and age tained in the present study and the other reference equa-
were the variables that remained in the proposed regres- tions for both sexes are presented in Figure 3, considering
sion models. The regression lines for boys and girls ob- the ideal (50th percentile).
Fig. 3. Regression lines obtained in the present study and the other reference equations for boys and girls. R5 ⫽ resistance at 5 Hz, R20 ⫽
resistance at 20 Hz, X5 ⫽ reactance at 5 Hz, Fres ⫽ resonant frequency.
Accompanying this statistical behavior of the dependent 4. Park JH, Yoon JW, Shin YH, Jee HM, Wee YS, Chang SJ, et al.
variables, the described coefficients of determination ex- Reference values for respiratory system impedance using impulse
oscillometry in healthy preschool children. Korean J Pediatr 2011;
plained the model proposed here satisfactorily and with
54(2):64-68.
higher values than the other publications on the subject, 5. Gube M, Brand P, Conventz A, Ebel J, Goeen T, Holzinger K, et al.
given that the adjusted R2 remained around 46.5% in boys Spirometry, impulse oscillometry and capnovolumetry in welders
and 53.2% in girls. It should be noted that the findings of and healthy male subjects. Respir Med 2009;103(9):1350-1357.
this research reveal a greater influence of predictive fac- 6. Nowowiejska B, Tomalak W, Radliński J, Siergiejko G, Latawiec
W, Kaczmarski M. Transient reference values for impulse oscillom-
tors on the impulse oscillometry system parameters than the
etry for children aged 3-18 years. Pediatr Pulmonol 2008;43(12):
results of studies of other nationalities in previous years. 1193-1197.
Amra et al22 investigated a similar age group and found 7. Meraz EG, Homer N, Ramos C, Rodriguez L, Madrigal LR, Castillo
that height and age were the variables best correlated to NG. Impulse oscillometric features and respiratory system models
the oscillometric parameters. It is important to emphasize track small airway function in children. Pract Appl Biomed Eng
that the relationship between these variables and the im- 2013;1(1):103-140. doi: 10.5772/52579.
8. Hagiwara S, Mochizuki H, Muramatsu R, Koyama H, Yagi H, Nishida
pulse oscillometry system data for R5 and X5 presented Y. Reference values for Japanese children’s respiratory resistance
the lowest determination coefficients (3–27%). In other using the LMS method. Allergol Int 2014;63(1):113-119.
studies, the coefficients ranged from 21 to 43% and from 9. Moreau L, Crenesse D, Berthier F, Albertini M. Relationship be-
13 to 30%.22,24 tween impulse oscillometry and spirometric indices in cystic fibrosis
The publications described above relate to schoolchil- children. Acta Paediatr 2009;98(6):1019-1023.
10. Komarow HD, Skinner J, Young M, Gaskins D, Nelson C, Gergen
dren; however, more recent studies on the determination of
PJ, Metcalfe DD. A study of the use of impulse oscillometry in the
equations/reference values for the impulse oscillometry evaluation of children with asthma: analysis of lung parameters,
system have investigated even younger populations, such order effect, and utility compared with spirometry. Pediatr Pulmonol
as preschoolers, due to the ease of application in this age 2012;47(1):18-26.
group.4,31,34 However, these studies have a limitation, which 11. El-Nemr FM, Al-Ghndour M. Study on the use of impulse oscillom-
is low coefficients of determination for the variables etry in the evaluation of children with asthma. Menoufia Med J
2013;26(2):151-158. doi: 10.4103/1110-2098.126149.
(⬃20%).4,42 12. Lipson DA, Holsclaw D, Imbesi G, Ferrin M, Sims M, Miller S, et
Although studies on the determination of reference equa- al. Evidence of elevated CXCR2 agonists in stable outpatients with
tions for the impulse oscillometry system in children have cystic fibrosis compared with healthy controls. J Pulm Respir Med
included different ages, frequencies, and acquisition times, 2013;3(3):1-5. doi: 10.4172/2161-105X.1000149.
most of them have found that height is an influential ele- 13. Stanojevic S, Wade A, Lum S, Stocks J. Reference equations for
pulmonary function tests in preschool children: a review. Pediatr
ment in preparing the equations. A possible limitation of Pulmonol 2007;42(10):962-72.
this study was the extensive list of criteria that children 14. Gochicoa-Rangel L, Torre-Bouscoulet L, Martínez-Briseño D, Ro-
had to meet to be considered healthy, which resulted in a dríguez-Moreno L, Cantú-González G, Vargas MH. Values of im-
smaller sample. In addition, the study was conducted in pulse oscillometry in healthy Mexican children and adolescents. Re-
few Brazilian cities, representing the behavior of that pop- spir Care 2015;60(1):119-127.
15. Hur HY, Kwak JH, Kim HY, Jung DW, Shin YH, Han MY. A
ulation. The reason for this is the lack of impulse oscil-
comparison between impulse oscillometry system and spirometry for
lometry system devices available in the country and the spirometry for detecting airway obstruction in children. Korean J Pe-
fact that this was a pioneer study on the topic. diatr 2008;51(8):842-847. doi: 10.3345/kjp.2008.51.8.842.
16. Solé D, Vanna AT, Yamada E, Rizzo MCV, Naspitz CK. Interna-
Conclusions tional study of asthma and allergies in childhood (ISAAC) written
questionnaire: validation of the asthma component among Brazilian
children. J Investig Allergol Clin Immunol 1998;8(6):376-82.
Reference equations were developed from the impulse os- 17. Vanna AT, Yamada E, Arruda LK, Naspitz CK, Solé D. Interna-
cillometry system parameters of children and adolescents, tional study of asthma and allergies in childhood: validation of the
considering height as the most influential predictor variable rhinitis symptom questionnaire and prevalence of rhinitis in school-
in most oscillometric parameters in such a population. children in São Paulo, Brazil. Pediatr Allergy Immunol 2001;12(2):
95-101.
18. Behl RK, Kashyap S, Sarkar M. Prevalence of bronchial asthma in
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