Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Prediction of Brobchodilator Response by Using $FEF_{25{\sim}75%}$ in Adult Patient with a Normal Spirometry Result

정상 폐활량을 보이는 성인 환자에서 $FEF_{25{\sim}75%}$를 통한 기관지확장제 반응의 예견

  • Park, Se-Hwan (Division of Pulmology and Allergy, Department of Internal Medicine, Eulji Medical Center, Eulji University School of Medicine) ;
  • Lee, Seung-Yup (Division of Pulmology and Allergy, Department of Internal Medicine, Eulji Medical Center, Eulji University School of Medicine) ;
  • Kang, Seung-Mo (Division of Pulmology and Allergy, Department of Internal Medicine, Eulji Medical Center, Eulji University School of Medicine) ;
  • Seon, Choon-Sik (Division of Pulmology and Allergy, Department of Internal Medicine, Eulji Medical Center, Eulji University School of Medicine) ;
  • Kim, Hyun-Kyung (Division of Pulmology and Allergy, Department of Internal Medicine, Eulji Medical Center, Eulji University School of Medicine) ;
  • Lee, Byoung-Hoon (Division of Pulmology and Allergy, Department of Internal Medicine, Eulji Medical Center, Eulji University School of Medicine) ;
  • Lee, Jae-Hyung (Division of Pulmology and Allergy, Department of Internal Medicine, Eulji Medical Center, Eulji University School of Medicine) ;
  • Kim, Sang-Hoon (Division of Pulmology and Allergy, Department of Internal Medicine, Eulji Medical Center, Eulji University School of Medicine)
  • 박세환 (을지대학교 의과대학 을지병원 호흡기알레르기내과학교실) ;
  • 이승엽 (을지대학교 의과대학 을지병원 호흡기알레르기내과학교실) ;
  • 강승모 (을지대학교 의과대학 을지병원 호흡기알레르기내과학교실) ;
  • 선춘식 (을지대학교 의과대학 을지병원 호흡기알레르기내과학교실) ;
  • 김현경 (을지대학교 의과대학 을지병원 호흡기알레르기내과학교실) ;
  • 이병훈 (을지대학교 의과대학 을지병원 호흡기알레르기내과학교실) ;
  • 이재형 (을지대학교 의과대학 을지병원 호흡기알레르기내과학교실) ;
  • 김상훈 (을지대학교 의과대학 을지병원 호흡기알레르기내과학교실)
  • Received : 2011.05.13
  • Accepted : 2011.08.03
  • Published : 2011.09.30
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Abstract

Background: When patients with chronic respiratory symptoms have a normal spirometry result, it is not always easy to consider bronchial asthma as the preferential diagnosis. Forced expiratory flow between 25% and 75% of vital capacity ($FEF_{25{\sim}75%}$) is known as a useful diagnostic value of small airway diseases. However, it is not commonly used, because of its high individual variability. We evaluated the pattern of bronchodilator responsiveness (BDR) and the correlation between $FEF_{25{\sim}75%}$ and BDR in patients with suspicious asthma and normal spirometry. Methods: Among patients with suspicious bronchial asthma, 440 adult patients with a normal spirometry result (forced expiratory volume in one second [$FEV_1$]/forced vital capacity [FVC] ${\geq}70%$ & $FEV_1%$ predicted ${\geq}80%$) were enrolled. We divided this group into a positive BDR group (n=43) and negative BDR group (n=397), based on the result of BDR. A comparison was carried out of spirometric parameters with % change of $FEV_1$ after bronchodilator (${\Delta}FEV_1%$). Results: Among the 440 patients with normal spirometry, $FEF_{25{\sim}75%}%$ predicted were negatively correlated with ${\Delta}FEV_1%$ (r=-0.22, p<0.01), and BDR was positive in 43 patients (9.78%). The means of $FEF_{25{\sim}75%}%$ predicted were $64.0{\pm}14.5%$ in the BDR (+) group and $72.9{\pm}20.8%$ in the BDR (-) group (p<0.01). The negative correlation between $FEF_{25{\sim}75%}%$ predicted and ${\Delta}FEV_1%$ was stronger in the BDR (+) group (r=-0.38, p=0.01) than in the BDR (-) group (r=-0.17, p<0.01). In the ROC curve analysis, $FEF_{25{\sim}75%}$ at 75% of predicted value had 88.3% sensitivity and 40.3% specificity for detecting a positive BDR. Conclusion: BDR (+) was not rare in patients with suspicious asthma and normal spirometry. In these patients, $FEF_{25{\sim}75%}%$ predicted was well correlated with BDR.

Keywords

References

  1. Kaplan AG, Balter MS, Bell AD, Kim H, McIvor RA. Diagnosis of asthma in adults. CMAJ 2009;181:E210-20. https://doi.org/10.1503/cmaj.080006
  2. Hamid Q, Song Y, Kotsimbos TC, Minshall E, Bai TR, Hegele RG, et al. Inflammation of small airways in asthma. J Allergy Clin Immunol 1997;100:44-51. https://doi.org/10.1016/S0091-6749(97)70193-3
  3. Alberts WM, Ferris MC, Brooks SM, Goldman AL. The FEF25-75% and the clinical diagnosis of asthma. Ann Allergy 1994;73:221-5.
  4. Lougheed MD, Lemiere C, Dell SD, Ducharme FM, Fitzgerald JM, Leigh R, et al. Canadian Thoracic Society Asthma Management Continuum--2010 Consensus summary for children six years of age and over, and adults. Can Respir J 2010;17:15-24. https://doi.org/10.1155/2010/827281
  5. Choi BW, Yoo KH, Jeong JW, Yoon HJ, Kim SH, Park YM, et al. Easy diagnosis of asthma: computer-assisted, symptom-based diagnosis. J Korean Med Sci 2007;22: 832-8. https://doi.org/10.3346/jkms.2007.22.5.832
  6. McFadden ER Jr, Linden DA. A reduction in maximum mid-expiratory flow rate. A spirographic manifestation of small airway disease. Am J Med 1972;52:725-37. https://doi.org/10.1016/0002-9343(72)90078-2
  7. Jung SY, Lee ES, Lee YH, Moon HK. Evaluation of the severity in patients with bronchial asthma using FEF25-75%. J Korean Pediatr Soc 2001;44:916-21.
  8. Rhee KH, Kim JK, Kim JH, Lim DH, Son BK. Usefulness of FEF25-75% in methacholine bronchial provocation test in children with asthma. Pediatr Allergy Respir Dis 2005;15:408-14.
  9. Ciprandi G, Signori A, Tosca MA, Cirillo I. Bronchodilation test in patients with allergic rhinitis. Allergy 2011; 66:694-8. https://doi.org/10.1111/j.1398-9995.2011.02544.x
  10. Simon MR, Chinchilli VM, Phillips BR, Sorkness CA, Lemanske RF Jr, Szefler SJ, et al. Forced expiratory flow between 25% and 75% of vital capacity and FEV1/forced vital capacity ratio in relation to clinical and physiological parameters in asthmatic children with normal FEV1 values. J Allergy Clin Immunol 2010;126:527-34.e1-8. https://doi.org/10.1016/j.jaci.2010.05.016
  11. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J 2005;26:319-38. https://doi.org/10.1183/09031936.05.00034805
  12. Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, et al. Interpretative strategies for lung function tests. Eur Respir J 2005;26:948-68. https://doi.org/10.1183/09031936.05.00035205
  13. Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2010. GINA; c2010 [cited 2011 Sep 14]. Available from: http://www. ginasthma.org/pdf/GINA_Report_2010.pdf.
  14. Sposato B, Mariotta S, Ricci A. When should a reversibility test be performed on patients with early stages of asthma and normal spirometry? J Asthma 2008;45: 479-83. https://doi.org/10.1080/02770900802069125
  15. Scichilone N, Battaglia S, Olivieri D, Bellia V. The role of small airways in monitoring the response to asthma treatment: what is beyond FEV1? Allergy 2009;64: 1563-9. https://doi.org/10.1111/j.1398-9995.2009.02139.x
  16. Mariotta S, Sposato B, Ricci A, Bruno P, Aquilini M, Mannino F. Reversibility test in the early stages of bronchial asthma. J Asthma 2005;42:487-91.
  17. Gelb AF, Williams AJ, Zamel N. Spirometry. FEV1 vs FEF25-75 percent. Chest 1983;84:473-4. https://doi.org/10.1378/chest.84.4.473
  18. Hansen JE, Sun XG, Wasserman K. Discriminating measures and normal values for expiratory obstruction. Chest 2006;129:369-77. https://doi.org/10.1378/chest.129.2.369
  19. Bellia V, Cibella F, Cuttitta G, Scichilone N, Mancuso G, Vignola AM, et al. Effect of age upon airway obstruction and reversibility in adult patients with asthma. Chest 1998;114:1336-42. https://doi.org/10.1378/chest.114.5.1336
  20. Chotirmall SH, Watts M, Branagan P, Donegan CF, Moore A, McElvaney NG. Diagnosis and management of asthma in older adults. J Am Geriatr Soc 2009;57: 901-9. https://doi.org/10.1111/j.1532-5415.2009.02216.x