How to interpret reduced forced expiratory volume in 1 s (FEV1)/vital capacity ratio with normal FEV1

Barisione, Giovanni; Crimi, Emanuele; Bartolini, Stefano; Saporiti, Riccardo; Copello, F; Pellegrino, Riccardo; Brusasco, Vito

doi:10.1183/09031936.00183708

Cited by 20 publications

(18 citation statements)

References 39 publications

(45 reference statements)

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“…Airway hyper-responsiveness is used as a tool in the diagnosis, classification of severity [8] and management [9,10] of asthma. AHR is useful in those who report symptoms [9], particularly in those with normal baseline lung function as measured by spirometry [11]. The presence of AHR is associated with increased decline in lung function [12], even in those with asymptomatic AHR [13], increased risk for the development of asthma [12] and increased likelihood of the persistence of wheeze from childhood to adulthood [14].…”

Section: Clinical Importancementioning

confidence: 99%

Mechanisms of airway hyper‐responsiveness in asthma: the past, present and yet to come

Chapman

Irvin

2015

Clin Experimental Allergy

120

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Airway hyperresponsiveness (AHR) has long been considered a cardinal feature of asthma. The development of the measurement of AHR forty years ago initiated many important contributions to our understanding of asthma and other airway diseases. However, our understanding of AHR in asthma remains complicated by the multitude of potential underlying mechanisms which in reality are likely to have different contributions amongst individual patients. Therefore the present review will discuss the current state of understanding of the major mechanisms proposed to contribute to AHR and highlight the way in which AHR testing is beginning to highlight distinct abnormalities associated with clinically relevant patient populations. In doing so we aim to provide a foundation by which future research can begin to ascribe certain mechanisms to specific patterns of bronchoconstriction and subsequently match phenotypes of bronchoconstriction with clinical phenotypes. We believe that this approach is not only within our grasp but will lead to improved mechanistic understanding of asthma phenotypes and hopefully better inform the development of phenotype-targeted therapy.

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Section: Clinical Importancementioning

confidence: 99%

Mechanisms of airway hyper‐responsiveness in asthma: the past, present and yet to come

Chapman

Irvin

2015

Clin Experimental Allergy

120

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“…On the other hand, a decreased FEV 1 /VC ratio is not always an unquestionable sign of disease. In a study of 1386 subjects undergoing spirometry testing for preventive medicine, a reduced FEV 1 /VC ratio with FEV 1 within or above the normal range was found in about 3% . Of these subjects, 62% had questionnaire responses and additional pulmonary function tests suggestive of an obstructive disorder (asthma or COPD), but the remaining had lung function indistinguishable from a control group of definitely healthy subjects (Fig.…”

Section: Current Use Of Lung Function Testing In Clinical Practicementioning

confidence: 99%

“…The phase III slope was significantly increased in 13 subjects with responses to questionnaire suggestive of COPD . Reprinted from B arisione et al . COPD , chronic obstructive pulmonary disease; FEV 1 , forced expiratory volume in 1 s; LLN , lower limit of normal; VC , vital capacity.…”

Section: Current Use Of Lung Function Testing In Clinical Practicementioning

confidence: 99%

Pulmonary physiology: Future directions for lung function testing in COPD

Brusasco¹,

Barisione²,

Crimi³

2014

Respirology

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Chronic obstructive pulmonary disease (COPD) is a term that encompasses different pathological conditions having excessive airflow limitation in common.A wide body of knowledge has been accumulated over the last century explaining the mechanisms by which airway (chronic bronchitis) and parenchymal (emphysema) diseases lead to an indistinguishable spirometric abnormality. Although the definition of emphysema is anatomical, early studies showed that its presence can be inferred with good approximation from measurements of lung mechanics and gas exchange, in addition to simple spirometry. Studies using tests of ventilation distribution showed that abnormalities are present in smokers with normal spirometry, although these tests were not predictive of development of COPD. At the beginning of the third millennium, new documents and guidelines for diagnosis and treatment of COPD were developed, in which the functional diagnosis of COPD was restricted, for the sake of simplicity, to simple spirometry. In recent years, there has been a resurgence of interest in separating bronchitic from emphysematous phenotype of COPD. For this purpose, high-resolution computed tomography scanning has been added to diagnostic work-up. At the same time, methods for lung function testing have been refined and seem promising for detection of early small airways abnormalities. Among them are the forced oscillation technique and the nitrogen phase III slope analysis of the multiple-breath washout test, which may provide information on ventilation inhomogeneity. Moreover, the combined assessment of diffusing capacity for nitric oxide and carbon monoxide may be more sensitive than the latter alone for partitioning diffusive components at parenchymal level. We report the case of an elderly male former smoker suffering from exertional breathlessness. He presented with relatively normal spirometry and lung volumes but severe abnormalities of pulmonary diffusion. High resolution computed tomography of the chest showed evidence of bilateral lower-lobe reticular pattern with upper-lobe emphysema consistent with a diagnosis of combined pulmonary fibrosis and emphysema (CPFE) syndrome. Main teaching points:• Limitations of spirometry as the only functional evaluation in smokers with suspected COPD • Cigarette smoking may cause a wide spectrum of pulmonary injuries • Usefulness of comprehensive physiological studies bs_bs_banner

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“…Another hypothesis for the cause of the fixed airflow obstruction observed in the FAO group is dysanaptic lung growth. Dysanaptic lung growth is defined as an incongruence between the growth of the lung parenchyma and the caliber of the airway, as observed by an abnormal FEV 1 /FVC ratio, with the FEV 1 in the normal range 36,37 . Interestingly, the FAO group presented FEV 1 values of approximately 80% of the predicted values at the 4‐year follow‐up.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for fixed airflow obstruction in children and adolescents with asthma: 4‐Year follow‐up

Sousa

Cabral

Martins

et al. 2020

Pediatric Pulmonology

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Background Asthma is a disease with reversible bronchoconstriction; however, some patients develop fixed airflow obstruction (FAO). Previous studies have reported the incidence and risk factors of FAO in adults; however, the corresponding factors in children remain poorly understood. Aim To evaluate the incidence and risk factors of FAO in children and adolescents with asthma. Method Observational and prospective cohort study with a 4‐year follow‐up of clinically stable patients with asthma (from 6‐8 years old). Anthropometric data, history of asthma, number of hospitalizations, frequent exacerbations, asthma severity, asthma control, inhaled corticosteroid dose, atopy, and lung function were analyzed as potential risk factors for FAO. FAO was defined by a ratio of the forced expiratory volume in the first second to the forced vital capacity below the lower limit of normal, even after inhaled and oral corticosteroid treatment. Results Four hundred and twenty‐eight patients were recruited, and 358 were analyzed. The FAO incidence in children and adolescents with asthma was 9.5% (n = 34), starting at 10 years of age. Age, body mass index, hospitalizations for asthma, bronchodilator response, frequent exacerbations, length of exacerbations, and asthma severity were associated with FAO. Frequent exacerbations (odds ratio [OR] = 4.0; 95% confidence interval [CI] = 1.3‐11.7) and asthma severity categorized as steps 4 to 5 (OR = 3.5; 95% CI = 1.6‐7.6) remained risk factors. Conclusions Frequent exacerbations and asthma severity are the risk factors for FAO in children and adolescents with asthma.

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How to interpret reduced forced expiratory volume in 1 s (FEV1)/vital capacity ratio with normal FEV1

Cited by 20 publications

References 39 publications

Mechanisms of airway hyper‐responsiveness in asthma: the past, present and yet to come

Mechanisms of airway hyper‐responsiveness in asthma: the past, present and yet to come

Pulmonary physiology: Future directions for lung function testing in COPD

Risk factors for fixed airflow obstruction in children and adolescents with asthma: 4‐Year follow‐up

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