{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T04:58:58Z","timestamp":1774673938237,"version":"3.50.1"},"reference-count":35,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2021,3,19]],"date-time":"2021-03-19T00:00:00Z","timestamp":1616112000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Discriminating between cardiac and pulmonary dyspnea is essential for patients\u2019 management. We investigated the feasibility and ability of forced oscillation techniques (FOT) in distinguishing between acute exacerbation of COPD (AECOPD), and acute decompensated heart failure (ADHF) in a clinical emergency setting. We enrolled 49 patients admitted to the emergency department (ED) for dyspnea and acute respiratory failure for AECOPD, or ADHF, and 11 healthy subjects. All patients were able to perform bedside FOT measurement. Patients with AECOPD showed a significantly higher inspiratory resistance at 5 Hz, Xrs5 (179% of predicted, interquartile range, IQR 94\u2013224 vs. 100 IQR 67\u2013149; p = 0.019), and a higher inspiratory reactance at 5 Hz (151%, IQR 74\u2013231 vs. 57 IQR 49\u201399; p = 0.005) than patients with ADHF. Moreover, AECOPD showed higher heterogeneity of ventilation (respiratory system resistance difference at 5 and 19 Hz, Rrs5-19: 1.49 cmH2O\/(L\/s), IQR 1.03\u20132.16 vs. 0.44 IQR 0.22\u20130.76; p = 0.030), and a higher percentage of flow limited breaths compared to ADHF (10%, IQR 0\u2013100 vs. 0 IQR 0\u201312; p = 0.030). FOT, which resulted in a suitable tool to be used in the ED setting, has the ability to identify distinct mechanical properties of the respiratory system in AECOPD and ADHF.<\/jats:p>","DOI":"10.3390\/diagnostics11030554","type":"journal-article","created":{"date-parts":[[2021,3,21]],"date-time":"2021-03-21T22:00:37Z","timestamp":1616364037000},"page":"554","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Distinct Mechanical Properties of the Respiratory System Evaluated by Forced Oscillation Technique in Acute Exacerbation of COPD and Acute Decompensated Heart Failure"],"prefix":"10.3390","volume":"11","author":[{"given":"Silvia","family":"Terraneo","sequence":"first","affiliation":[{"name":"Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, Universit\u00e0 degli Studi di Milano, 20142 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3999-5298","authenticated-orcid":false,"given":"Rocco Francesco","family":"Rinaldo","sequence":"additional","affiliation":[{"name":"Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, Universit\u00e0 degli Studi di Milano, 20142 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe Francesco","family":"Sferrazza Papa","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Universit\u00e0 degli Studi di Milano, 20142 Milan, Italy"},{"name":"Cardiovascular and Thoracic Department, SC Pneumologia U, Citt\u00e0 della Salute e della Scienza (Molinette) University Hospital, 10126 Turin, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fulvia","family":"Ribolla","sequence":"additional","affiliation":[{"name":"Pneumologia AOU San Luigi Gonzaga, 10043 Orbassano, Turin, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlo","family":"Gulotta","sequence":"additional","affiliation":[{"name":"Respiratory Unit, Papa Giovanni XXIII Hospital, Department of Health Sciences, Universit\u00e0 degli Studi di Milano, 24127 Bergamo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Maugeri","sequence":"additional","affiliation":[{"name":"Respiratory Unit, Papa Giovanni XXIII Hospital, Department of Health Sciences, Universit\u00e0 degli Studi di Milano, 24127 Bergamo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emiliano","family":"Gatti","sequence":"additional","affiliation":[{"name":"Respiratory Unit, Papa Giovanni XXIII Hospital, Department of Health Sciences, Universit\u00e0 degli Studi di Milano, 24127 Bergamo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefano","family":"Centanni","sequence":"additional","affiliation":[{"name":"Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, Universit\u00e0 degli Studi di Milano, 20142 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1743-0504","authenticated-orcid":false,"given":"Fabiano","family":"Di Marco","sequence":"additional","affiliation":[{"name":"Casa di Cura del Policlinico, Department of Neurorehabilitation Sciences, 20144 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,3,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1944","DOI":"10.1001\/jama.294.15.1944","article-title":"Does This Dyspneic Patient in the Emergency Department Have Congestive Heart Failure?","volume":"294","author":"Wang","year":"2005","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"46","DOI":"10.5811\/westjem.2015.11.28525","article-title":"Point-of-Care Multi-Organ Ultrasound Improves Diagnostic Accuracy in Adults Presenting to the Emergency Department with Acute Dyspnea","volume":"17","author":"Mantuani","year":"2016","journal-title":"West. J. Emerg. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1016\/j.jjcc.2014.02.003","article-title":"Cardiovascular function and prognosis of patients with heart failure coexistent with chronic obstructive pulmonary disease","volume":"64","author":"Yoshihisa","year":"2014","journal-title":"J. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1183\/09031936.00044411","article-title":"Unrecognised ventricular dysfunction in COPD","volume":"39","author":"Macchia","year":"2011","journal-title":"Eur. Respir. J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1016\/j.jjcc.2014.05.003","article-title":"Chronic obstructive pulmonary disease: Pathophysiological impact on heart failure in real clinical situation","volume":"64","author":"Ishizu","year":"2014","journal-title":"J. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.jacc.2006.08.046","article-title":"Diagnostic and Therapeutic Challenges in Patients with Coexistent Chronic Obstructive Pulmonary Disease and Chronic Heart Failure","volume":"49","author":"Padeletti","year":"2007","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1054\/jcaf.2002.126916","article-title":"Airway resistance in chronic heart failure measured by impulse oscillometry","volume":"8","author":"Witte","year":"2002","journal-title":"J. Card. Fail."},{"key":"ref_8","unstructured":"(2021, March 17). Global Strategy for Diagnosis, Management, and Prevention of COPD\u20132017. Available online: https:\/\/goldcopd.org\/wp-content\/uploads\/2017\/02\/wms-GOLD-2017-FINAL.pdf."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1152\/jappl.1959.14.6.905","article-title":"Influence of acute pulmonary vascular congestion on recoiling force of excised cats\u2019 lung","volume":"14","author":"Frank","year":"1959","journal-title":"J. Appl. Physiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1152\/jappl.1956.8.6.587","article-title":"Oscillation Mechanics of Lungs and Chest in Man","volume":"8","author":"Dubois","year":"1956","journal-title":"J. Appl. Physiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1152\/jappl.1959.14.2.167","article-title":"Static volume-pressure interrelations of the lungs and pulmonary blood vessels in excised cats\u2019 lungs","volume":"14","author":"Frank","year":"1959","journal-title":"J. Appl. Physiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.1152\/jappl.1992.73.3.1040","article-title":"Lung and chest wall impedances in the dog in normal range of breathing: Effects of pulmonary edema","volume":"73","author":"Barnas","year":"1992","journal-title":"J. Appl. Physiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1183\/09031936.93.06060772","article-title":"Respiratory mechanics studied by forced oscillations during artificial ventilation","volume":"6","author":"Peslin","year":"1993","journal-title":"Eur. Respir. J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2207","DOI":"10.1016\/j.rmed.2006.03.009","article-title":"Detection of changes in respiratory mechanics due to increasing degrees of airway obstruction in asthma by the forced oscillation technique","volume":"100","author":"Cavalcanti","year":"2006","journal-title":"Respir. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1016\/j.rmed.2006.09.001","article-title":"The utility of the forced oscillation technique in assessing bronchodilator responsiveness in patients with asthma","volume":"101","author":"Yaegashi","year":"2007","journal-title":"Respir. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1186\/1465-9921-9-51","article-title":"Changes in the mechanical properties of the respiratory system during the development of interstitial lung edema","volume":"9","author":"Zannin","year":"2008","journal-title":"Respir. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2129","DOI":"10.1093\/eurheartj\/ehw128","article-title":"2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC","volume":"37","author":"Ponikowski","year":"2016","journal-title":"Eur. Heart J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1183\/09031936.04.00014304","article-title":"Standards for the diagnosis and treatment of patients with COPD: A summary of the ATS\/ERS position paper","volume":"23","author":"Celli","year":"2004","journal-title":"Eur. Respir. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1183\/09031936.03.00089403","article-title":"The forced oscillation technique in clinical practice: Methodology, recommendations and future developments","volume":"22","author":"Oostveen","year":"2003","journal-title":"Eur. Respir. J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1183\/09031936.04.00046804","article-title":"De-tection of expiratory flow limitation in COPD using the forced oscillation technique","volume":"23","author":"Dellaca","year":"2004","journal-title":"Eur. Respir. J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1183\/09031936.00038006","article-title":"Expiratory flow limitation detected by forced oscillation and negative expiratory pressure","volume":"29","author":"Duffy","year":"2006","journal-title":"Eur. Respir. J."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Collins, S.P., Lindsell, C.J., Peacock, W.F., Eckert, D.C., Askew, J., and Storrow, A.B. (2006). Clinical characteristics of emergency department heart failure patients initially diagnosed as non-heart failure. BMC Emerg. Med., 6.","DOI":"10.1186\/1471-227X-6-11"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1378\/chest.14-2608","article-title":"Lung Ultrasound-Implemented Diagnosis of Acute Decompensated Heart Failure in the ED","volume":"148","author":"Pivetta","year":"2015","journal-title":"Chest"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1177\/2048872614551505","article-title":"Impact of patient positioning on lung ultrasound findings in acute heart failure","volume":"4","author":"Frasure","year":"2015","journal-title":"Eur. Hear. J. Acute Cardiovasc. Care"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1016\/j.rmed.2005.10.008","article-title":"Comparison of the acute effect of tiotropium versus a combination therapy with single inhaler budesonide\/formoterol on the degree of resting pulmonary hyperinflation","volume":"100","author":"Santus","year":"2006","journal-title":"Respir. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1832","DOI":"10.4187\/respcare.03066","article-title":"Spirometric Standards and Patient Characteristics: An Exploratory Study of Factors Affecting Fulfillment in Routine Clinical Practice","volume":"59","author":"Giner","year":"2014","journal-title":"Respir. Care"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1378\/chest.06-0530","article-title":"FEV 1 Performance among Patients with Acute Asthma","volume":"131","author":"Silverman","year":"2007","journal-title":"Chest"},{"key":"ref_28","first-page":"892","article-title":"Spirometric correlates of dyspnea improvement among emergency department patients with chronic obstructive pulmonary disease exacerbation","volume":"53","author":"Tsai","year":"2008","journal-title":"Respir. Care"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.2147\/COPD.S102222","article-title":"Accuracy of forced oscillation technique to assess lung function in geriatric COPD population","volume":"11","author":"Tse","year":"2016","journal-title":"Int. J. Chronic Obstr. Pulm. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1566","DOI":"10.1378\/chest.113.6.1566","article-title":"Respiratory Resistance in the Emergency Department","volume":"113","author":"Ducharme","year":"1998","journal-title":"Chest"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2795","DOI":"10.1093\/eurheartj\/eht192","article-title":"Heart failure and chronic obstructive pulmonary disease: The challenges facing physicians and health services","volume":"34","author":"Hawkins","year":"2013","journal-title":"Eur. Hear. J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1910","DOI":"10.1016\/j.ijcard.2012.12.083","article-title":"Airway obstruction in systolic heart failure\u2013COPD or congestion?","volume":"168","author":"Brenner","year":"2013","journal-title":"Int. J. Cardiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1152\/japplphysiol.01031.2017","article-title":"Oscillometry and pulmonary MRI measurements of ventilation heterogeneity in obstructive lung disease: Relationship to quality of life and disease control","volume":"125","author":"Young","year":"2018","journal-title":"J. Appl. Physiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1192","DOI":"10.1152\/jappl.1997.83.4.1192","article-title":"Relationship between heterogeneous changes in airway morphometry and lung resistance and elastance","volume":"83","author":"Lutchen","year":"1997","journal-title":"J. Appl. Physiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.rmed.2017.04.006","article-title":"Cardiopulmonary exercise testing and second-line pulmonary function tests to detect obstructive pattern in symptomatic smokers with borderline spirometry","volume":"127","author":"Terraneo","year":"2017","journal-title":"Respir. Med."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/11\/3\/554\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:38:23Z","timestamp":1760161103000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/11\/3\/554"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,19]]},"references-count":35,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,3]]}},"alternative-id":["diagnostics11030554"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics11030554","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,19]]}}}