Could FEV<sub>1</sub>decline have a role in daily clinical practice for asthma monitoring?

Sposato, Bruno

doi:10.1185/03007995.2013.821057

Cited by 6 publications

(12 citation statements)

References 112 publications

(137 reference statements)

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“…However, asthma guidelines [1] do not suggest using slower/not easily detectable FEV 1 long-term decline to establish if lung function (and therefore asthma) worsened after several years despite a good asthma control. In fact, if FEV 1 , checked after inhaling bronchodilator, is compared to previous measurements (effected at least 5 years earlier) [3] and if a FEV 1 change >30 ml/year or ≥15% is found, such decrease should be regarded as pathological (airway obstruction) [2, 3]. Significant long term FEV 1 reduction/decline measurements can be considered an indirect method for assessing bronchial wall thickening and disease progression [3].…”

Section: Introductionmentioning

confidence: 99%

“…In fact, if FEV 1 , checked after inhaling bronchodilator, is compared to previous measurements (effected at least 5 years earlier) [3] and if a FEV 1 change >30 ml/year or ≥15% is found, such decrease should be regarded as pathological (airway obstruction) [2, 3]. Significant long term FEV 1 reduction/decline measurements can be considered an indirect method for assessing bronchial wall thickening and disease progression [3]. However, FEV 1 changes may be mistaken for those occurring among repeated measurements [2, 4].…”

Section: Introductionmentioning

confidence: 99%

“…However, FEV 1 changes may be mistaken for those occurring among repeated measurements [2, 4]. Therefore, we should evaluate them by comparing such FEV 1 changes with an at least five-year-old measurement, in order not to confuse deterioration due to remodeling with the above said lung function fluctuations [3]. We know that “declining” asthmatics, whose significant irreversible airways obstruction develops over time, are approximately 20-35% of asthmatic patients.…”

Section: Introductionmentioning

confidence: 99%

“…This may also regard asthmatics with pulmonary function within the predicted normal range if their latest “normal” lung function is compared with an at least five-year-old higher measurement. This apparent “normality” is due to a yearly predicted reference reduction that may hide a possible lung function decline due to asthma, leading to an underestimation of airflow limitation [3, 5]. In fact, pulmonary function might be within the predicted normal range despite a significant lung function decline.…”

Section: Introductionmentioning

confidence: 99%

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Predicted Values for Spirometry may Underestimate Long-Standing Asthma Severity

Sposato

2016

TORMJ

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Background:Asthma may show an accelerated lung function decline. Asthmatics, although having FEV1 and FEV1/VC (and z-scores) higher than the lower limit of normality, may show a significant FEV1 decline when compared to previous measurements. We assessed how many asymptomatic long-standing asthmatics (LSA) with normal lung function showed a significant FEV1 decline when an older FEV1 was taken as reference point.Methods:46 well-controlled LSA (age: 48.8±12.1; 23 females) with normal FEV1 and FEV1/VC according to GLI2012 references (FEV1: 94.8±10.1%, z-score:-0.38±0.79; FEV1/VC: 79.3±5.2, z-score:-0.15±0.77) were selected. We considered FEV1 decline, calculated by comparing the latest value to one at least five years older or to the highest predicted value measured at 21 years for females and 23 for males. A FEV1 decline >15% or 30 ml/years was regarded as pathological.Results:When comparing the latest FEV1 to an at least 5-year-older one (mean 8.1±1.4 years between 2 measurements), 14 subjects (30.4%) showed a FEV1 decline <5% (mean: -2.2±2.6%), 19 (41.3%) had a FEV1 5-15% change (mean: -9.2±2.5%) and 13 (28.3%) a FEV1 decrease>15% (mean: -18.3±2.4). Subjects with a FEV1 decline>30 ml/year were 28 (60.8%). When using the highest predicted FEV1 as reference point and declines were corrected by subtracting the physiological decrease, 6 (13%) patients showed a FEV1 decline higher than 15%, whereas asthmatics with a FEV1 loss>30 ml/year were 17 (37%).Conclusion:FEV1 decline calculation may show how severe asthma actually is, avoiding a bronchial obstruction underestimation and a possible under-treatment in lots of apparent “well-controlled” LSA with GLI2012-normal-range lung function values.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predicted Values for Spirometry may Underestimate Long-Standing Asthma Severity

Sposato

2016

TORMJ

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“…A Danish study found that the loss of lung function in patients with asthma was 16 mL/year higher than for people without asthma (82), who are usually assumed to have a loss of 18–26 mL/year (83, 84). However, data suggest large individual differences in annual loss of lung function in patients with asthma.…”

Section: Indicator 4: Lung Functionmentioning

confidence: 99%

The Danish National Database for Asthma: establishing clinical quality indicators

Hansen

Hoffmann-Petersen

Sverrild

et al. 2016

European Clinical Respiratory Journal

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Asthma is one of the most common chronic diseases worldwide affecting more than 300 million people. Symptoms are often non-specific and include coughing, wheezing, chest tightness, and shortness of breath. Asthma may be highly variable within the same individual over time. Although asthma results in death only in extreme cases, the disease is associated with significant morbidity, reduced quality of life, increased absenteeism, and large costs for society. Asthma can be diagnosed based on report of characteristic symptoms and/or the use of several different diagnostic tests. However, there is currently no gold standard for making a diagnosis, and some degree of misclassification and inter-observer variation can be expected. This may lead to local and regional differences in the treatment, monitoring, and follow-up of the patients. The Danish National Database for Asthma (DNDA) is slated to be established with the overall aim of collecting data on all patients treated for asthma in Denmark and systematically monitoring the treatment quality and disease management in both primary and secondary care facilities across the country. The DNDA links information from population-based disease registers in Denmark, including the National Patient Register, the National Prescription Registry, and the National Health Insurance Services register, and potentially includes all asthma patients in Denmark. The following quality indicators have been selected to monitor trends: first, conduction of annual asthma control visits, appropriate pharmacological treatment, measurement of lung function, and asthma challenge testing; second, tools used for diagnosis in new cases; and third, annual assessment of smoking status, height, and weight measurements, and the proportion of patients with acute hospital treatment. The DNDA will be launched in 2016 and will initially include patients treated in secondary care facilities in Denmark. In the nearby future, the database aims to include asthma diagnosis codes and clinical data registered by general practitioners and specialised practitioners as well.

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