Airway resistance at maximum inhalation as a marker of asthma and airway hyperresponsiveness

Mendonça, Nancy T; Kenyon, Jennifer; LaPrad, Adam S.; Syeda, Sohera N.; O’Connor, George T.; Lutchen, Kenneth R.

doi:10.1186/1465-9921-12-96

Cited by 8 publications

(15 citation statements)

References 17 publications

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“…On the basis of our study, and confirmed by other researches already quoted, a greater impairment of FEF 25-75 % seems to correspond to a more severe AHR 6,16,18,19. This is especially in line with the findings of Currie et al42 who compared asthmatic patients with borderline Mch measured AHR to those with moderate-to-severe AHR, where the latter had significantly lower FEF 25-75 % values.…”

Section: Discussionsupporting

confidence: 93%

“…Results of our study are in accordance with other studies where impaired FEF 25-75 values are inversely related to airway AHR both in children and adults affected by rhinitis and/or asthma 14,15,16,17,18,19. Therefore, when facing a FEF 25-75 impairment associated with normal FEV1 and FEV1/FVC in patients with asthma symptoms, we are expected to think that AHR, and consequently asthma, may be present.…”

Section: Discussionsupporting

confidence: 92%

“…Although there are no recommendations regarding the utility of FEF 25-75 (% of the predicted) by the various guidelines,1,11,12,13 this measurement may have a clinical significance in the diagnosis and management of asthma. In this regard some studies provide evidence that impaired FEF 25-75 values might predict airway AHR in subjects affected by rhinitis and/or asthma both in children and adults 14,15,16,17,18,19. Furthermore, impaired MEF 50 or FEF 25-75 values may be considered a reliable marker of a positive bronchial reversibility after a bronchodilator both in adults and children with asthma and/or rhinitis when the baseline spirometry shows normal values of FEV1 and FEV1/FVC 7,8,9,10,20.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Small Airway Impairment and Bronchial Hyperresponsiveness in Asthma Onset

Sposato

Scalese

Migliorini

et al. 2014

Allergy Asthma Immunol Res

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PurposeOur study tried to find a relationship between baseline FEF25-75% and airway hyperresponsiveness (AHR) and whether a greater FEF25-75% impairment may be a marker of a more severe hyperresponsiveness in subjects with normal FEV1 and FEV1/FVC and suggestive asthma symptoms. Besides, we tried to asses a FEF25-75% cut-off value to identify hyper-reactive subjects.Methods4,172 subjects (2,042 M; mean age: 38.3±14.9; mean FEV1 % predicted: 100.5±12.7 and FEV1/FVC: 85.4±6.8) were examined after performing a methacholine (Mch) test. All subjects reported a symptom onset within 3 years before the test. Subjects with PD20<400 or >400 µg were arbitrarily considered affected by moderate/severe and borderline AHR, respectively.ResultsPD20 values were 213 (IQR:86-557), 340 (IQR:157-872) and 433 (IQR:196-1032) µg in subjects with baseline FEF25-75≤50%, FEF25-75 between 50 and 70% and FEF25-75>70% respectively (P<0.0001). Only in moderate/severe hyper-reactive subjects (excluded borderlines), PD20 was lower in the FEF25-75≤50% subgroup than in the 1 with FEF25-75>70%. The hyperreactive subjects percentage, was higher in those with FEF25-75≤50% and lower in those with FEF25-75>70% (P<0.0001). FEF25-75<50% (compared to FEF25-75>70%) was a higher AHR risk factor, especially in subjects with moderate/severe AHR (OR: 2.18 [IQR:1.41-3.37]; P<0.0001). Thresholds yielding the highest combined sensitivity/specificity for FEF25-75% were 75.19 (area under curve [AUC]: 0.653) and 74.95 (AUC:0.688) in subjects with PD20<2,400 and <400 µg respectively. FEV1, FVC, and FEV1/FVC measured in subjects with different FEF25-75≤50%, FEF25-75>50 and ≤70% or FEF25-75>70% levels were similar both in normoreactive and hyperreactive subjects.ConclusionsAt asthma onset, reduced baseline FEF25-75 values with normal FEV1 and FEV1/FVC may predict AHR. Detectable predictive cut-off values do not exist because even normoreactive subjects can show lower FEF25-75 values. Furthermore, a greater FEF25-75 reduction may be associated to a more severe AHR, suggesting a possible FEF25-75 role in the management of asthma when FEV1 and FEV1/FVC are normal.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Small Airway Impairment and Bronchial Hyperresponsiveness in Asthma Onset

Sposato

Scalese

Migliorini

et al. 2014

Allergy Asthma Immunol Res

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“…Our methods applied a semiautomated approach to the segmentation of ventilated airspaces [ 30 ] leading to a novel index to quantify the degree of heterogeneity throughout the imaged lung. Hence, we can quantitatively relate such heterogeneity to alterations in dynamic mechanical lung function sensitive to airways, tissues, and the degree of heterogeneous constriction [ 3 , 20 , 21 , 33 , 34 , 36 ] as well as the overall reactivity (PC 20 ) [ 4 , 12 , 15 ]. Similar to prior studies [ 7 ], we found that both healthy subjects that withhold DIs and mild-to-moderate asthmatics bronchoconstricted when exposed to airway agonist.…”

Section: Discussionmentioning

confidence: 99%

Linking Ventilation Heterogeneity Quantified via Hyperpolarized 3He MRI to Dynamic Lung Mechanics and Airway Hyperresponsiveness

et al. 2015

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Advancements in hyperpolarized helium-3 MRI (HP 3He-MRI) have introduced the ability to render and quantify ventilation patterns throughout the anatomic regions of the lung. The goal of this study was to establish how ventilation heterogeneity relates to the dynamic changes in mechanical lung function and airway hyperresponsiveness in asthmatic subjects. In four healthy and nine mild-to-moderate asthmatic subjects, we measured dynamic lung resistance and lung elastance from 0.1 to 8 Hz via a broadband ventilation waveform technique. We quantified ventilation heterogeneity using a recently developed coefficient of variation method from HP 3He-MRI imaging. Dynamic lung mechanics and imaging were performed at baseline, post-challenge, and after a series of five deep inspirations. AHR was measured via the concentration of agonist that elicits a 20% decrease in the subject’s forced expiratory volume in one second compared to baseline (PC20) dose. The ventilation coefficient of variation was correlated to low-frequency lung resistance (R = 0.647, P < 0.0001), the difference between high and low frequency lung resistance (R = 0.668, P < 0.0001), and low-frequency lung elastance (R = 0.547, P = 0.0003). In asthmatic subjects with PC20 values <25 mg/mL, the coefficient of variation at baseline exhibited a strong negative trend (R = -0.798, P = 0.02) to PC20 dose. Our findings were consistent with the notion of peripheral rather than central involvement of ventilation heterogeneity. Also, the degree of AHR appears to be dependent on the degree to which baseline airway constriction creates baseline ventilation heterogeneity. HP 3He-MRI imaging may be a powerful predictor of the degree of AHR and in tracking the efficacy of therapy.

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“…Seven of the included articles reported oscillometry (IOS/FOT) [22][23][24][25][26][27][28] and five reported MMEF. 23 29-31 None of the included studies reported MBW use in diagnosing asthma.…”

Section: Study Characteristicsmentioning

confidence: 99%

Physiological tests of small airways function in diagnosing asthma: a systematic review

et al. 2020

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BackgroundAsthma is a common, heterogeneous disease that is characterised by chronic airway inflammation and variable expiratory airflow limitation. Current guidelines use spirometric measures for asthma assessment. This systematic review aimed to assess whether the most commonly reported tests of small airways function could contribute to the diagnosis of asthma.MethodsStandard systematic review methodology was used, and a range of electronic databases was searched (Embase, MEDLINE, CINAHL, CENTRAL, Web of Science, DARE). Studies that included physiological tests of small airways function to diagnose asthma in adults were included, with no restrictions on language or date. The risk of bias and quality assessment tools used were Agency for Healthcare Research and Quality tool for cross-sectional studies and Quality Assessment of Diagnostic Accuracy Studies 2 for diagnostic test accuracy (DTA) studies.Results7072 studies were identified and 10 studies met review criteria. 7 included oscillation techniques and 5 included maximal mid-expiratory flow (MMEF). Studies were small and of variable quality. In oscillometry, total resistance (R5) and reactance at 5 Hz (X5) was altered in asthma compared with healthy controls. The percentage predicted of MMEF was lower in patients with asthma compared with controls in all studies and lower than the % predicted forced expiratory volume in 1 s. In DTA of oscillometry, R5 showed a sensitivity between 69% and 72% and specificity between 61% and 86%.ConclusionThere were differences in the results of physiological tests of small airway function in patients with asthma compared with controls. However, studies are small and heterogeneous. Further studies are needed to assess the effectiveness of these tests on a larger scale, including studies to determine which test methodology is the most useful in asthma.

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Airway resistance at maximum inhalation as a marker of asthma and airway hyperresponsiveness

Cited by 8 publications

References 17 publications

Small Airway Impairment and Bronchial Hyperresponsiveness in Asthma Onset

Small Airway Impairment and Bronchial Hyperresponsiveness in Asthma Onset

Linking Ventilation Heterogeneity Quantified via Hyperpolarized 3He MRI to Dynamic Lung Mechanics and Airway Hyperresponsiveness

Physiological tests of small airways function in diagnosing asthma: a systematic review

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