Forced Oscillation Technique vs Fractional exhaled nitric oxide in Wheezing Children (1-10Years): A Comparative Study
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Abstract
Background: Diagnosing and monitoring asthma and recurrent wheezing in young children (1-10 years) remains challenging due to difficulties with conventional lung function tests. The Forced Oscillation Technique (FOT) and Fractional Exhaled Nitric Oxide (FeNO) are promising, child-friendly tools that assess airway mechanics and inflammation, respectively.
Aim: To compare the diagnostic utility of FOT and FeNO and evaluate the performance of a combined approach.
Methods: A comparative Cross-sectional study was conducted on 60 children aged 1-10 years with recurrent wheezing. All participants underwent simultaneous FOT and FeNO testing. FOT parameters measured included resistance at 5 Hz (R5), reactance at 5 Hz (X5), and the frequency dependence of resistance (R5-R20).
Results: The study included children (mean age 6.5 ± 2.7 years; 70% male) with a high rate of atopy. FOT results revealed significantly elevated airway resistance (R5 = 12.4 ± 3.1 cmH₂O/L/s), negative reactance indicating abnormal lung compliance (X5 = -4.2 ± 1.8 cmH₂O/L/s), and markedly elevated frequency dependence (R5-R20 = 3.6 ± 1.2 cmH₂O/L/s), consistent with small airway dysfunction. This Combined FOT and FeNo demonstrated excellent sensitivity (92%), high specificity (84%), and the highest overall diagnostic accuracy (AUC = 0.87).
Conclusion: FOT detects the mechanical consequences of airway disease, while FeNO identifies underlying Type 2 inflammation. Using FOT and FeNO together provides a comprehensive, non-invasive diagnostic strategy that mitigates the limitations of each test used alone.