FEF25-75% Is a More Sensitive Measure Reflecting Airway Dysfunction in Patients with Asthma: A Comparison Study Using FEF25-75% and FEV1%

Qin, Rundong; An, Jia-ying; Xie, Jiaxing; Huang, Renbin; Xie, Yanqing; He, Li; Xv, Hui; Qian, Geng; Li, Jing

doi:10.1016/j.jaip.2021.06.027

Cited by 34 publications

(20 citation statements)

References 34 publications

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“…Among the spirometry parameters, FEF25–75% pred, FEF50% pred, and FEF75% pred have been used to reflect SAD, especially FEF25–75% (Marazzini et al, 1989 ; Pellegrino et al, 2005 ; Fujisawa et al, 2013 ; Pisi et al, 2013 ; Mcnulty and Usmani, 2014 ; Yuan et al, 2019 ). Furthermore, a recently published study with a large sample suggested that FEF25–75% was a more sensitive measure reflecting SAD in patients with asthma (Qin et al, 2021 ). The cut-off points of middle expiratory flows for defining SAD were not compatible in different studies (Marazzini et al, 1989 ; Usmani et al, 2016 ; Yuan et al, 2019 ), however, the value of FEF25–75% pred (MMEF% pred) <65% has been used widely in finding small airway disease in previous research studies or guideline recommendations (Marazzini et al, 1989 ; Pellegrino et al, 2005 ; Pefura-Yone et al, 2014 ; Yi et al, 2020 ; Qin et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, a recently published study with a large sample suggested that FEF25–75% was a more sensitive measure reflecting SAD in patients with asthma (Qin et al, 2021 ). The cut-off points of middle expiratory flows for defining SAD were not compatible in different studies (Marazzini et al, 1989 ; Usmani et al, 2016 ; Yuan et al, 2019 ), however, the value of FEF25–75% pred (MMEF% pred) <65% has been used widely in finding small airway disease in previous research studies or guideline recommendations (Marazzini et al, 1989 ; Pellegrino et al, 2005 ; Pefura-Yone et al, 2014 ; Yi et al, 2020 ; Qin et al, 2021 ). In our study, SAD was indicated when any two parameters of MMEF% pred, FEF50% pred, and FEF75% pred were <65%, which mainly according to the SAD definition were used by previous studies aiming at the Chinese adult population with CVA or asthma (Gao et al, 2020 ; Xiao et al, 2020 ) and the recommendation of the Guidelines for Lung Function Examination in China [Pulmonary Function Workgroup of Chinese Society of Respiratorydiseases (CSRD) Chinese Medical Association, 2014 ].…”

Section: Discussionmentioning

confidence: 99%

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Small Airway Dysfunction in Cough Variant Asthma: Prevalence, Clinical, and Pathophysiological Features

Jiang

et al. 2022

Front. Physiol.

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Introduction: Small airway dysfunction (SAD) commonly presents in patients with classic asthma, which is associated with airway inflammation, disease severity, and asthma control. However, the prevalence of SAD, its relationship with cough severity and airway inflammation, and its development after antiasthmatic treatment in patients with cough variant asthma (CVA) need to be clarified. This study aimed to investigate the prevalence of SAD and its relationship with clinical and pathophysiological characteristics in patients with CVA and the change in small airway function after antiasthmatic treatment.Methods: We retrospectively analyzed 120 corticosteroid-naïve patients with CVA who had finished a standard questionnaire and relevant tests in a specialist cough clinic, such as cough visual analog scale (VAS), differential cells in induced sputum, fractional exhaled nitric oxide (FeNO) measurement, spirometry, and airway hyper-responsiveness. Information of 1-year follow-up was recorded in a part of patients who received complete cough relief after 2 months of treatment. SAD was defined as any two parameters of maximal mid-expiratory flow (MMEF)% pred, forced expiratory flow at 50% of forced vital capacity (FEF50%) pred, and forced expiratory flow at 75% of forced vital capacity (FEF75%) pred measuring <65%.Results: SAD occurred in 73 (60.8%) patients with CVA before treatment. The patients with SAD showed a significantly longer cough duration (24.0 vs. 6.0, p = 0.031), a higher proportion of women (78.1 vs. 59.6%, p = 0.029), older mean age (41.9 vs. 35.4, p = 0.005), and significantly lower forced expiratory volume in 1 s (FEV1%) pred, FEV1/FVC, MMEF% pred, FEF50% pred, FEF75% pred, PEF% pred, and PD20 (all p < 0.01) as compared with patients without SAD. There were no significant differences in cough VAS, sputum eosinophils count, FeNO, and TIgE level between patients with SAD and those without SAD. Among 105 patients who completed 2 months of antiasthmatic treatment and repeatedly experienced spirometry measurement, 57 (54.3%) patients still had SAD, despite a significant improvement in cough VAS, sputum eosinophils, FeNO, FEF50% pred, and PEF% pred (all p < 0.01). As compared with patients without SAD, patients with SAD showed no significant differences in the relapse rate (50.0 vs. 41.9%, p = 0.483) and wheeze development rate (10.4 vs. 0%, p = 0.063) during the follow-up.Conclusions: Small airway dysfunction occurred in over half of patients with CVA and persisted after short-term antiasthmatic treatment, which showed distinctive clinical and pathophysiological features.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Small Airway Dysfunction in Cough Variant Asthma: Prevalence, Clinical, and Pathophysiological Features

Jiang

et al. 2022

Front. Physiol.

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“…The presence of small airway dysfunction is a current topic of investigation in the adult population and has been recently published in a predominately adult population using functional characteristics of physical activity and symptom control [ 6 , 7 , 8 ]. Studies of this type can serve as a blueprint for prospective pediatric asthma investigation and potential earlier intervention, and are under-represented in the pediatric literature…”

Section: Discussionmentioning

confidence: 99%

“…We choose the top two measures found in the Postma and Qin protocols to be available and clinically relevant, FVC and FEF 25-75 [ 6 , 8 ]. The FEF 25-75 served as the principal surrogate in our study.…”

Section: Methodsmentioning

confidence: 99%

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An a Priori Approach to Small Airway Dysfunction in Pediatric Asthmatics

2022

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Small airway dysfunction remains a stepchild in the pediatric asthma care pathway. In brief, elements of the pulmonary function test (PFT) concerning smaller airway data remain less utilized. To further the value of the standard PFT we underwent a prospective Proof of Concept (POC) project, utilizing the outpatient performance of PFT tests in children 6–18 years during a 15-month period. The goal of the study was to determine if a priori the PFT represented a small airway disease pattern or not. Only the pulmonary function was used to make that distinction. Children 6–18 years with asthma who completed a PFT had their PFT as being characterized with or without a small airway dysfunction (SAD) designation, coded in the electronic medical record as an a priori decision using the code J98.4 (other disorders of lung) as a marker for electronic medical records retrieval. Subsequently, the results were analyzed between a group of 136 children designated (a priori) as having no small airway dysfunction in comparison to 91 children a priori designated as having small airway dysfunction. The a priori designation groups were post hoc compared for large and smaller airway function differences. Both large and smaller airway dysfunction were highly significantly different between the 2 groups, based solely on the initial division of the total group based on the decision the PFT represented a small airway pattern. We concluded the baseline pulmonary function test used in the evaluation of pediatric asthma has readily identifiable information regarding the presence of small airway dysfunction, and we characterized what was unique on the PFT based on that SAD classification

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Applying a new set of core outcome measures for severe pediatric asthma in real‐life: A single‐center experience

Votto,

De Filippo,

Marseglia

et al. 2023

Pediatric Pulmonology

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FEF25-75% Is a More Sensitive Measure Reflecting Airway Dysfunction in Patients with Asthma: A Comparison Study Using FEF25-75% and FEV1%

Cited by 34 publications

References 34 publications

Small Airway Dysfunction in Cough Variant Asthma: Prevalence, Clinical, and Pathophysiological Features

Small Airway Dysfunction in Cough Variant Asthma: Prevalence, Clinical, and Pathophysiological Features

An a Priori Approach to Small Airway Dysfunction in Pediatric Asthmatics

Applying a new set of core outcome measures for severe pediatric asthma in real‐life: A single‐center experience

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