Reversibility Test in the Early Stages of Bronchial Asthma

Mariotta, Salvatore; Sposato, B; Rícci, Alberto; Bruno, Pierdonato; Aquilini, Mauro; Mannino, F

doi:10.1081/jas-67536

Cited by 6 publications

(20 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is confirmed by previous studies that have shown a positive reversibility test after salbutamol (FEV1 increase >12%) in about 23-30% of subjects with FEV1>100% or FEV1/FVC >100% or FEF 25-75 >70% and bronchial asthma symptoms 7,8. The percentage of subjects with positive reversibility test increased to 35% when baseline FEF 25-75 was <70% 7,8. Therefore, subjects with a small airway impairment measured with a FEF 25-75 reduction, may already have an obstruction of proximal airways that could not be seen because of inadequate FEV1/VC or FEV1/FVC normality cut-offs.…”

Section: Discussionsupporting

confidence: 90%

“…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. In addition, there is evidence that FEF 25-75 may be also an asthma severity marker especially in subjects with normal FEV1 and FEV1/FVC.…”

Section: Introductionmentioning

confidence: 84%

“…Probably the normality cut-off of FEV1/VC or FEV1/FVC, indicated by guide-lines, is not representative of "normality" for all subjects 1,11,12,13. In fact, it is difficult to define a normality value which may be valid for all individuals because theoretical values, used to establish such limits, are not representative for all subjects, especially young adolescents 7,8,12,13. This is confirmed by previous studies that have shown a positive reversibility test after salbutamol (FEV1 increase >12%) in about 23-30% of subjects with FEV1>100% or FEV1/FVC >100% or FEF 25-75 >70% and bronchial asthma symptoms 7,8.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, it is difficult to define a normality value which may be valid for all individuals because theoretical values, used to establish such limits, are not representative for all subjects, especially young adolescents 7,8,12,13. This is confirmed by previous studies that have shown a positive reversibility test after salbutamol (FEV1 increase >12%) in about 23-30% of subjects with FEV1>100% or FEV1/FVC >100% or FEF 25-75 >70% and bronchial asthma symptoms 7,8. The percentage of subjects with positive reversibility test increased to 35% when baseline FEF 25-75 was <70% 7,8.…”

Section: Discussionmentioning

confidence: 99%

“…FEF 25-75 is generally considered as an approximate measure of the distal airways caliber and thus its reduction represents a small airways obstruction caused by asthma inflammation 2,3. Therefore, an isolated impairment of FEF 25-75 may be a marker of an early reduction of pulmonary function in asthma 4,5,6,7,8,9,10. 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.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Small Airway Impairment and Bronchial Hyperresponsiveness in Asthma Onset

Sposato

Scalese

Migliorini

et al. 2014

Allergy Asthma Immunol Res

Self Cite

View full text Add to dashboard Cite

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.

show abstract