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In small studies, impaired IOS relates better to respiratory symptoms than spirometry. We studied how IOS related to spirometry and respiratory symptoms in a large population of individuals (n=10\u2009360) in a cross-sectional analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Normal values for IOS and spirometry were defined in healthy, never-smoking individuals, aged 50\u201364\u2005years, from the Swedish CArdioPulmonary bioImage Study (n=3664 for IOS and 3608 for spirometry). For IOS, abnormal values for resistance at 5\u2005Hz (<jats:italic>R<\/jats:italic><jats:sub>5<\/jats:sub>) and at 20\u2005Hz and area of reactance were defined using the 95th percentile. Abnormal reactance at 5\u2005Hz for IOS and abnormal conventional spirometry indices (forced expiratory volume in 1\u2005s (FEV<jats:sub>1<\/jats:sub>), forced and slow vital capacity and their ratios) were defined using the 5th percentile.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Abnormal IOS parameters were found in 16% of individuals and were associated with increased odds ratios for nearly all respiratory symptoms when adjusted for age, gender and smoking. In individuals with normal spirometry, abnormal IOS resistance was related to cough and dyspnoea, while abnormal reactance was related to wheeze. In these individuals, the combination of abnormal<jats:italic>R<\/jats:italic><jats:sub>5<\/jats:sub>with abnormal reactance resulted in approximately two-fold higher likelihood for having cough, chronic bronchitis and dyspnoea, even when further adjusting for FEV<jats:sub>1<\/jats:sub>, expressed as % predicted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Abnormal IOS is related to increased respiratory burden in middle-aged individuals with normal spirometry, especially when resistance and reactance parameters are combined. The different relationships between respiratory symptoms and reactance and resistance warrant further research.<\/jats:p><\/jats:sec>","DOI":"10.1183\/23120541.00736-2022","type":"journal-article","created":{"date-parts":[[2023,6,29]],"date-time":"2023-06-29T12:15:16Z","timestamp":1688040916000},"page":"00736-2022","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":28,"title":["Impulse oscillometry indices in relation to respiratory symptoms and spirometry in the Swedish Cardiopulmonary Bioimage 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