title: Total inspiratory and expiratory impedance in patients with severe chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  Several studies have confirmed the high potential of the forced oscillation technique for the assessment of respiratory modifications related to chronic obstructive pulmonary disease. However, most of these studies did not employ within-breath analyses of the respiratory system. The aim of this study is to analyze respiratory impedance alterations in different phases of the respiratory cycle of chronic obstructive pulmonary disease patients and to evaluate their clinical use.
  
  
  METHODS
  39 individuals were evaluated, including 20 controls and 19 individuals with chronic obstructive pulmonary disease who experienced severe airway obstruction. We evaluated the mean respiratory impedance (Zm) as well as values for inspiration (Zi) and expiration cycles (Ze), at the beginning of inspiration (Zbi) and expiration (Zbe). The peak-to-peak impedance (Zpp), and the impedance change (ΔZrs) were also analyzed. The clinical usefulness was evaluated by investigating the sensibility, specificity and the area under the receiver operating characteristic curve.
  
  
  RESULTS
  The respiratory impedance increased in individuals with chronic obstructive pulmonary disease in all of the studied parameters (Zm, Zi, Ze, Zbi, Zbe, ΔZrs and Zpp). These changes were inversely associated with spirometric parameters. Higher impedances were observed in the expiratory phase of individuals with chronic obstructive pulmonary disease. All of the studied parameters, except for ΔZrs (area under the receiver operating characteristic ,0.8), exhibited high accuracy for clinical use (area under the receiver operating characteristic >0.90; Sensibility ≥ 0.85; Sp ≥ 0.85).
  
  
  CONCLUSIONS
  The respiratory alterations in severe chronic obstructive pulmonary disease may be identified by the increase in respiratory system impedance, which is more evident in the expiratory phase. These results confirm the potential of within-breath analysis of respiratory impedance for the assessment of respiratory modifications related to chronic obstructive pulmonary disease.
authors.affiliation: State University of Rio de Janeiro, Institute of Biology, Biomedical Instrumentation Laboratory, Rio de Janeiro/RJ, Brazil.
authors.forename: Karla Kristine Dames
authors.initials: KK
authors.lastname: Silva
authors.forename: Agnaldo José
authors.initials: AJ
authors.lastname: Lopes
authors.forename: José Manoel
authors.initials: JM
authors.lastname: Jansen
authors.forename: Pedro Lopes
authors.initials: PL
authors.lastname: de Melo
mesh_terms: D000368:Aged; D000403:Airway Resistance / Q000502:physiology*; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D017097:Electric Impedance; D045853:Exhalation / Q000502:physiology*; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology*; D006801:Humans; D001239:Inhalation / Q000502:physiology*; D008297:Male; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000503:physiopathology*; D012129:Respiratory Function Tests; D012680:Sensitivity and Specificity