Impulse oscillometry-derived respiratory mechanical abnormalities and fibrotic disease progression in interstitial lung disease: a single-center cohort study
- 1Department of Respiratory and Critical Care Medicine, the Affiliated Hospital of Xuzhou Medical University , ,
Abstract
Objective: To examine whether continuous impulse oscillometry (IOS)-derived respiratory mechanical measures are associated with subsequent fibrotic disease progression in interstitial lung disease (ILD).
Methods: In this single-center ambispective cohort study, 255 adults with fibrotic ILD underwent baseline spirometry, diffusing capacity testing and IOS. Fibrotic disease progression was defined using a PPF-like composite requiring at least two of three domains (worsening respiratory symptoms, physiological progression and radiological progression) within a 9–15-month assessment window. All IOS parameters were analyzed continuously using Firth penalized logistic regression, adjusted for age, sex, height and baseline FVC % predicted. X5 was additionally assessed using continuous scaling and restricted cubic splines. ROC analyses, non-IPF sensitivity analyses, and bootstrap validation were exploratory.
Results: Fibrotic disease progression occurred in 41 of 255 patients (16.1%). A 1-SD worsening in X5 was associated with higher odds of progression (OR 8.89, 95% CI 4.66–19.47; P<0.001), as were AX (OR 1.67, 95% CI 1.22–2.38; P = 0.001) and Fres (OR 1.61, 95% CI 1.11–2.36; P = 0.012). Each 0.01 kPa·s/L increase in X5 was associated with lower odds of progression (adjusted OR 0.67, 95% CI 0.59–0.76; P<0.001), and the X5–progression association was nonlinear (P for nonlinearity<0.001). After exclusion of IPF, X5 and AX remained associated with progression. Bootstrap validation showed improved discrimination after adding AX or X5, but did not constitute external validation.
Conclusions: Continuous IOS measures, particularly X5 and AX, were associated with subsequent fibrotic disease progression in this single-center ILD cohort, with a weaker signal for Fres. The X5 association was nonlinear and remained evident after exclusion of IPF. ROC-derived thresholds were unstable and should be considered exploratory. These findings support further evaluation of oscillometric respiratory-mechanical abnormalities in larger externally validated cohorts but do not establish clinically applicable predictive thresholds.
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BibTeX
@article{zhang2026impulse,
title = {{Impulse oscillometry-derived respiratory mechanical abnormalities and fibrotic disease progression in interstitial lung disease: a single-center cohort study}},
author = {Chuhan Zhang and Yiying Wang and Zhen Feng and Yitian Sun and Maowei Zhang and Yanan Liu and Bi Chen},
journal = {Frontiers in physiology},
year = {2026},
month = oct,
doi = {10.3389/fphys.2026.1962001},
url = {https://europepmc.org/article/PMC/PMC13724450},
note = {CC BY},
}
RIS
TY - JOUR
TI - Impulse oscillometry-derived respiratory mechanical abnormalities and fibrotic disease progression in interstitial lung disease: a single-center cohort study
AU - Chuhan Zhang
AU - Yiying Wang
AU - Zhen Feng
AU - Yitian Sun
AU - Maowei Zhang
AU - Yanan Liu
AU - Bi Chen
PY - 2026
DA - 2026/10/19
JO - Frontiers in physiology
DO - 10.3389/fphys.2026.1962001
UR - https://europepmc.org/article/PMC/PMC13724450
AB - Objective: To examine whether continuous impulse oscillometry (IOS)-derived respiratory mechanical measures are associated with subsequent fibrotic disease progression in interstitial lung disease (ILD). Methods: In this single-center ambispective cohort study, 255 adults with fibrotic ILD underwent baseline spirometry, diffusing capacity testing and IOS. Fibrotic disease progression was defined using a PPF-like composite requiring at least two of three domains (worsening respiratory symptoms, physiological progression and radiological progression) within a 9–15-month assessment window. All IOS parameters were analyzed continuously using Firth penalized logistic regression, adjusted for age, sex, height and baseline FVC % predicted. X5 was additionally assessed using continuous scaling and restricted cubic splines. ROC analyses, non-IPF sensitivity analyses, and bootstrap validation were exploratory. Results: Fibrotic disease progression occurred in 41 of 255 patients (16.1%). A 1-SD worsening in X5 was associated with higher odds of progression (OR 8.89, 95% CI 4.66–19.47; P<0.001), as were AX (OR 1.67, 95% CI 1.22–2.38; P = 0.001) and Fres (OR 1.61, 95% CI 1.11–2.36; P = 0.012). Each 0.01 kPa·s/L increase in X5 was associated with lower odds of progression (adjusted OR 0.67, 95% CI 0.59–0.76; P<0.001), and the X5–progression association was nonlinear (P for nonlinearity<0.001). After exclusion of IPF, X5 and AX remained associated with progression. Bootstrap validation showed improved discrimination after adding AX or X5, but did not constitute external validation. Conclusions: Continuous IOS measures, particularly X5 and AX, were associated with subsequent fibrotic disease progression in this single-center ILD cohort, with a weaker signal for Fres. The X5 association was nonlinear and remained evident after exclusion of IPF. ROC-derived thresholds were unstable and should be considered exploratory. These findings support further evaluation of oscillometric respiratory-mechanical abnormalities in larger externally validated cohorts but do not establish clinically applicable predictive thresholds.
SN - 1664-042X
ER -