Airway resistance measured by the interrupter technique: expiration or inspiration, mean or median?

The measurement of airway resistance by the interrupter technique (Rint) needs standardization. Should measurements be made be during the expiratory or inspiratory phase of tidal breathing? In reported studies, the measurement of Rint has been calculated as the median or mean of a small number of values, is there an important difference? Subjects were 2.5-5.0 yrs (median 4.0 yrs) who had previous respiratory symptoms. The Rint in expiration (RintE) and inspiration (RintI) pre and postsalbutamol, the coefficient of variation (CV) of values contributing to measurements, and bronchodilator responsiveness(BDR) in both phases were compared. Measurements using median and mean were compared. RintE was higher than RintI by 4% (p < 0.01). The CV of values making up RintE and RintI, and BDR measured in expiration and inspiration were similar. The median difference between means and medians of values making up measurements was 0.6% (range -6-11%). RintE has been shown to be consistently greater then RintI but the difference in this study is small. It is suggested that one or the other is chosen as the standard. In the present data the mean of a set of values contributing to a measurement was not significantly different from the median. However, the use of the median has been recommended since it is less affected by possible outlying values such as might be included by fully automated equipment.