Figures
- FIGURE 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram for the identification and selection process of studies that developed reference equations for oscillometric parameters of interest. #: MEDLINE: 348 results; Embase: 832 results; PubMed: 348 results; Scopus: 623 results; Web of Science Core Collection: 122 results; Cochrane Database of Systematic Reviews: 19 results; Google Scholar: first 100 results used; Cochrane Protocols: no results; PROSPERO: no results.
- FIGURE 2
Bubble plot of the relative number of studies identified that developed oscillometric reference equations for three major ethnic groups in the past 20 years. Bubble size indicates the number of publications.
- FIGURE 3
Differences in predicted values for oscillometric indices of interest from reference equations of included studies as functions of height for men and women. Predicted values for resistance and reactance at 6 Hz and 19 Hz are considered for some equations, please see the text and footnote of table 3 for details. R5: resistance at 5 Hz; R20: resistance at 20 Hz; X5: reactance at 5 Hz; AX: reactance area.
Tables
- TABLE 1
Characteristics of included studies that developed reference equations for oscillometric parameters of interest
Study Study country Study population Oscillometry device(s) Signal type Frequencies considered (Hz) Reference parameters Smoker inclusion Shiota et al. [22] Japan Non-Caucasian MasterScreen IOS Recurrent impulses 5, 20 R5, R20, X5 Never-smokers, active smokers, ex-smokers Newbury et al. [20] Australia Caucasian MasterScreen IOS Recurrent impulses 5, 10, 15, 20, 25, 35 Z5, Rrs, Xrs Never-smokers, ex-smokers Brown et al. [18] Australia Caucasian Custom-made Pseudorandom 6, 11, 19 Rrs, Xrs Never-smokers, ex-smokers Aarli et al. [24] Norway Caucasian MasterScreen IOS Recurrent impulses 5, 20 R5, R20, X5, Fres, AX Never-smokers, ex-smokers Schulz et al. [23] Germany Caucasian MasterScreen IOS Recurrent impulses 5, 20 Z5, R5, R20, R5–20, X5, Fres, AX Never-smokers only Oostveen et al. [16] Belgium, the Netherlands, Hungary, Australia Caucasian Custom-made (C1, C3), ROS Oscilink (C2), Quark i2m (C4), MasterScreen IOS (C5) Pseudorandom (C1–C4), recurrent impulses (C5) 4, 5, 6, 8, 10, 12, 14, 15, 16, 18, 20, 22, 24, 26 Rrs, Rm, Xrs, Fres, AX Never-smokers, ex-smokers Ribeiro et al. [21] Brazil Caucasian,
Non-CaucasianCustom-made Pseudorandom 4, 6, 8, 10, 12, 14, 16, 18, 20, 22 Zrs, Rrs, Rm, R0, Xrs, Fres, Xm Never-smokers only De et al. [19] India Non-Caucasian Resmon Pro Pseudorandom, relative primes 5, 19 R5, R19, R5–19, X5 Never-smokers only Moitra et al. [15] India Non-Caucasian MasterScreen IOS Recurrent impulses 5, 20 Z5, R5, R20, R5–20, X5, Fres, AX Never-smokers only Berger et al. [17] USA Caucasian MasterScreen IOS Recurrent impulses 5, 10, 15, 20 R5, R10, R15, R20, R5–15, R5–20, X5, X10, Fres, AX Never-smokers only IOS: impulse oscillometry; R5: resistance at 5 Hz; R20: resistance at 20 Hz; X5: reactance at 5 Hz; Z5: impedance at 5 Hz; Rrs: respiratory resistance; Xrs: respiratory reactance; Fres: resonant frequency; AX: reactance area; Rm: mean respiratory resistance; R0: resistance at 0 Hz; R19: resistance at 19 Hz.
- TABLE 2
Subject demographics from included studies that developed reference equations for oscillometric parameters of interest
Study Subjects (n) Males (n) Height (cm) Weight (kg) Age (years) Smoking history (pack-years) Shiota et al. [22] 166 69 162.7±8.3 58.9±11.2 38.6±17.2 (20–81) 22.2±22.1 Newbury et al. [20] 125 59 175.89±8.77
164.58±6.5687.3±11.49
73.3±12.4149.54 (25–74)
48.76 (25–74)<5 Brown et al. [18] 904 341 176.7±6.7
163.5±6.584.2±13.1
69.3±13.555.6±17.5
54.7±17.7<5 Aarli et al. [24] 75 40 173±6
159±676.4±12.7
65.5±10.879.4±6.9
78.8±6.320/4 Schulz et al. [23]# 397 154 173.30 (163.00–188.41)
160.07 (149.00–172.24)80.89 (67.02–106.76)
68.37 (53.40–91.05)64.89 (46.00–84.75)
67.26 (46.00–85.00)0 Oostveen et al. [16] 368 180 171.44# 54–128
43–11149.55# (18–84) 4.4 Ribeiro et al. [21] 288 144 173±1 (153–189)
160±1 (145–181)78.78±2.07 (49–128)
65.02±1.79 (47–96)49.04±2.88 (20–81)
49.0±2.88 (20–86)De et al. [19] 323 122 168.1±8.2
154.8±6.565.5±13.3 42.7±13.7
40.9±13.7<1 Moitra et al. [15] 190 92 45±18
41±17Berger et al. [17] 439 223 177±7 (157–203)
164±7 (146–183)83.1±17.1 (51.3–170.0)
63.9±12.7 (43.1–147.4)46.7±11.2 (21–85)
44.0±11.9 (21–76)<5 Data are presented as pooled totals (n) or according to sex (male/female) in mean±sd or mean (range), unless otherwise indicated. #: calculated from means of subgroups within study.
- TABLE 3
Reference equations developed from included studies for oscillometric parameters of interest
Study Indices Male Female Shiota et al. [22] R5 R5=8.67158−3.841167·log(h) R5=8.67158−3.841167·log(h) R20 R20=5.841867−2.546561·log(h) R20=5.841867−2.546561·log(h) X5 X5= −2.343672−0.000097a+1.018597·log(h) X5= −2.343672−0.000097a+1.018597·log(h) AX Not available Not available Newbury et al. [20] R5 R5=1.1672−0.0017a−0.007h+0.0043w R5=0.768−0.00064a−0.00276h R20 R20=0.9216−0.0013a−0.0049h+0.0027w R20=0.4821+0.00034a−0.00125h X5 X5= −0.3593+0.00013a+0.0016h X5= −0.4689−0.00092a+0.00245h AX Not available Not available Brown et al. [18]# R6 log(R6)=3.18955−0.01617h+0.00882w log(R6)=3.88965−0.01944h+0.00812w R19 log(R19)=2.89318−0.01445h+0.00789w log(R19)=3.25796−0.01519h+0.00605w X6 exp(X6)= −1.23047+0.01286a−0.00013712a2+0.01098h−0.00323w exp(X6)= −1.36295+0.00845a−0.0001035a2+0.01282h−0.00449w AX Not available Not available Aarli et al. [24] R5 ln(R5)=3.02−0.023h ln(R5)=2.68−0.026h+0.012w R20 ln(R20)=1.52−0.016h ln(R20)=1.26−0.017h+0.009w X5 ln(−X5)=3.57−0.033h ln(−X5)=3.85−0.041h+0.014w AX ln(AX)=12.0−0.074h ln(AX)=10.8−0.074h Schulz et al. [23] R5 5th quantile: R5=1.0685571−0.0022403a−0.004312h R5=0.5012224+0.0002940a−0.0037866h+0.0045199w 50th quantile: R5=0.9861137−0.0001223a−0.0055278h+0.0029891w R5=0.7887960+0.0015118a−0.0046594h+0.0029768w 95th quantile: R5=0.6683472+0.0029051a−0.0026280h R5=0.1926787+0.0004133a+0.0016756h R20 5th quantile: R20=0.6342369−0.0019656a−0.0021069h R20=0.5970057−0.0006897a−0.0030934h+0.0016623h 50th quantile: R20=0.7722257−0.0006446a−0.0037120h+0.0013924w R20=0.4505645+0.0001251a−0.0020488h+0.0017939w 95th quantile: R20=1.1824320−0.0003590a−0.0048639h R20=0.8177947−0.0003549a−0.0025771h X5 5th quantile: X5= −0.5568254−0.0004762a+0.0025397h X5= −0.5446960−0.0018068a+0.0029323h 50th quantile: X5= −0.4670275−0.0003344a+0.0027755h−0.0010424w X5= −0.3313017−0.0007541a+0.0022090h−0.001413w 95th quantile: X5= −0.2058333+0.0006944a+0.0006944h X5= −0.1831886+0.0003607a+0.0005743h AX 5th quantile: AX=0.0430162+0.0012195a−0.0002327h AX=1.0968758−0.0001349a−0.0077805h+0.0048793w 50th quantile: AX=1.7584772+0.0027451a−0.0132469h+0.0077552w AX=1.7909627+0.0110077a−0.0168559h+0.0104360w 95th quantile: AX=2.2955939+0.0161916a−0.0139157h AX=2.7124098+0.0173679a−0.0227368h+0.0152978w Oostveen et al. [16]¶,+ R5 ln(R5)=5.327−0.00381a−3.032h+0.01390w ln(R5)=2.591+0.00279a−1.461h+0.0121w R20 ln(R20)=3.540−0.0033a−1.824h+0.00888w ln(R20)=2.482+0.00135a−1.122h+0.00695w X5 ln(4−X5)=2.683+0a−0.703h+0.0019w ln(4−X5)=2.373+0.0015a−0.607h+0.00312w AX5 ln(AX5)=9.730+0a−6.107h+0.02122w ln(AX5)=5.490+0.00960a−4.122h+0.02836w Ribeiro et al. [21]#,¶ R6 ln(R6)=2.964−0.002a−1.545h+0.009w R6=8.164−0.006a−3.563h+0.014w R20 ln(R20)=2.196−0.002a−0.970h+0.005w R20=9.142−0.005a−3.811h+0.003w X6 exp(X6)= −1.082+0a+0.983h−0.003w X6= −5.293+0a+2.759h−0.007w AX Not available Not available De et al. [19]# R5 R5=10.035+0.008a−0.057h+0.036w R5=9.697−0.046h+0.033w R19 R19=8.077−0.040h+0.02w R19=8.683−0.038h+0.019w X5 X5= −3.334−0.004a+0.018h−0.009w X5= −4.40+0.02h AX Not available Not available Moitra et al. [15]¶ R5 ln(R5)= −0.30+0.003a−0.83h+0.01w ln(R5)=0.003+0.004a−0.66h+0.007w R20 ln(R20)= −0.14−0.001a−0.99h+0.01w ln(R20)=0.164+0.0003a−0.92h+0.007w X5 X5= −0.23−0.002a+0.15h−0.002w X5= −0.60−0.004a+0.37h−0.001w AX ln(AX)= −0.20+1.24ln(a)−2.98h+0.01w ln(AX)= −2.33+0.76ln(a)−0.004h+0.004w Berger et al. [17]¶,+ R5 ln(R5)=2.07069−1.05124h+0.03337·BMI ln(R5)=2.22395−0.98351h+0.02903·BMI R20 ln(R20)=1.95570−0.81148h+0.02042·BMI ln(R20)=2.01077−0.72768h+0.02009·BMI X5 ln(X5+4)=0.10509+0.82626h−0.01775·BMI ln(X5+4)=0.29066+0.73387h−0.01984·BMI AX ln(AX)=4.36142−3.47450h+0.08784·BMI ln(AX)=4.67153−3.31633h+0.06719·BMI Reference equations developed by included studies for R6, R19 and X6 instead of R5, R19 and X5, respectively were considered. Respiratory resistance (Rrs) and respiratory reactance (Xrs) measured in kPa·L−1·s−1 and AX measured in kPa·L−1 unless otherwise indicated. Age (a), height (h), weight (w) and body mass index (BMI) measured in years, cm, kg and kg·m−2, respectively, unless otherwise indicated. Shiota et al. [22] developed unisex reference equations. Schulz et al. [23] developed reference equations for the 5th, 50th and 95th quantiles. For Oostveen et al. [16] the equations for AX5 are included. R5: resistance at 5 Hz; R20: resistance at 20 Hz; X5: reactance at 5 Hz; AX: reactance area; R6: resistance at 6 Hz; R19: resistance at 19 Hz; X6: reactance at 6 Hz. #: Rrs and Xrs measured in cmH2O·L−1·s−1 and AX measured in cmH2O·L−1; ¶: height measured in metres (m); +: Rrs and Xrs measured in hPa·L−1·s−1 and AX measured in hPa·L−1.
- TABLE 4
Assessments of agreement between predicted values for oscillometric parameters of interest from reference equations of included studies and a standard reference for men and women
Oostveen et al. [16] versus Sex R5 R20 X5 AX Shiota et al. [22] Male Bias (LoA) 0.15 (0.06, 0.25) 0.08 (0.01, 0.15) −0.02 (−0.03, −0.01) NA ρc 0.19 0.22 0.65 NA Female Bias (LoA) 0.09 (−0.05, 0.23) 0.09 (0.006, 0.17) −0.01 (−0.04, 0.01) NA ρc 0.14 0.15 0.67 NA Newbury et al. [20] Male Bias (LoA) 0.07 (0.04, 0.10) 0.03 (0.02, 0.05) −0.01 (−0.03, 0.005) NA ρc 0.41 0.57 0.68 NA Female Bias (LoA) −0.01 (−0.07, 0.04) 0.04 (0.01, 0.07) 0.001 (−0.02, 0.02) NA ρc 0.27 0.11 0.93 NA Brown et al. [18]# Male Bias (LoA) −0.69 (−0.94, −0.43) −0.57 (−0.78, −0.36) −0.06 (−0.08, −0.03) NA ρc 0.03 0.02 0.10 NA Female Bias (LoA) −1.35 (−2.09, −0.61) −1.09 (−1.59, −0.60) −0.06 (−0.09, −0.04) NA ρc 0.006 0.007 0.09 NA Aarli et al. [24] Male Bias (LoA) −0.16 (−0.24, −0.08) −0.06 (−0.11, −0.02) 0.03 (0.01, 0.06) −0.26 (−0.69, 0.18) ρc 0.16 0.28 0.55 0.31 Female Bias (LoA) −0.21 (−0.41, −0.01) −0.07 (−0.11, −0.04) 0.03 (−0.01, 0.07) 0.01 (−0.30, 0.32) ρc 0.05 0.17 0.44 0.49 Schulz et al. [23] Male Bias (LoA) 0.01 (−0.02, 0.04) 0.04 (0.006, 0.07) −0.02 (−0.04, −0.006) 0.20 (0.09, 0.31) ρc 0.84 0.55 0.55 0.18 Female Bias (LoA) 0.01 (−0.01, 0.04) 0.06 (0.03, 0.08) −0.03 (−0.04, −0.01) −0.25 (−0.66, 0.15) ρc 0.79 0.10 0.46 0.28 Ribeiro et al. [21]# Male Bias (LoA) 0.02 (−0.03, 0.06) 0.02 (−0.006, 0.04) −0.006 (−0.02, 0.01) NA ρc 0.66 0.55 0.86 NA Female Bias (LoA) −0.01 (−0.05, 0.04) 0.02 (−0.02, 0.06) 0.01 (−0.01, 0.03) NA ρc 0.43 0.51 0.72 NA De et al. [19]¶ Male Bias (LoA) −0.05 (−0.11, 0.01) −0.01 (−0.03, 0.01) 0.004 (−0.03, 0.04) NA ρc 0.34 0.78 0.59 NA Female Bias (LoA) −0.12 (−0.15, −0.10) −0.05 (−0.06, −0.03) 0.003 (−0.02, 0.03) NA ρc 0.05 0.22 0.73 NA Moitra et al. [15] Male Bias (LoA) −0.15 (−0.25, −0.06) −0.06 (−0.10, −0.02) 0.09 (0.01, 0.17) −0.68 (−1.46, 0.10) ρc −0.01 0.11 −0.02 0.03 Female Bias (LoA) −0.33 (−0.38, −0.28) −0.09 (−0.11, −0.08) 0.12 (0.02, 0.21) −1.68 (−2.68, −0.69) ρc 0.01 0.06 0.12 0.02 Berger et al. [17] Male Bias (LoA) −0.03 (−0.07, 0.01) −0.04 (−0.06, −0.01) −0.01 (−0.02, −0.0001) 0.16 (0.05, 0.26) ρc 0.59 0.37 0.89 0.18 Female Bias (LoA) −0.07 (−0.10, −0.03) −0.04 (−0.06, −0.03) −0.0001 (−0.02, 0.02) 0.17 (0.06, 0.28) ρc 0.18 0.28 0.82 0.20 Data presented as bias (lower and upper LoA) and Lin's concordance correlation coefficient (ρc). Reference values developed by Oostveen et al. [16] were considered as the standard model and these were compared with other reference values for R5, R20 and X5. Bias and LoA should be read as a percentage (e.g. a bias of 0.15 should be read as 15%). #: resistance and reactance values measured at 6 Hz (R6, X6) and 19 Hz (R19) were considered in the comparison; ¶: resistance value at 19 Hz (R19) was considered in the comparison. R5: resistance at 5 Hz; R20: resistance at 20 Hz; X5: reactance at 5 Hz; AX: reactance area; LoA: limit of agreement; NA: not applicable.
Supplementary Material
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Supplementary material ERR-0021-2022.SUPPLEMENT
