Spirometry, bronchodilator test or symptom scoring for the assessment of childhood asthma

Abstract

The value of spirometry, the bronchodilator test and 2 weeks' symptom scoring for the assessment of the severity of childhood asthma was studied in a series of 65 consecutively referred school-aged asthmatic children, with the diurnal peak expiratory flow (PEF) variability in home recordings serving as a golden standard. The amplitude of the peak expiratory flow rate (PEFR) variation could be best predicted by the baseline forced expiratory volume in 1 s (FEV1) and the past history of the symptom rate, the correlation with FEV1 being -0.48, p < 0.001. Although the baseline forced expiratory flow between 25 and 75% of the forced vital capacity (FEF25-75%) and the responses of FEV1 and FEF25-75% to salbutamol also showed significant correlations with the diurnal PEFR variability (r = -0.43, r = 0.47 and 0.41, p < 0.001, respectively), these variants did not improve the regression model. The baseline FEV1. FEF25-75% and PEFR and their responses to salbutamol also had a slight but statistically significant correlation with the methacholine threshold, but the symptom score on the diary card did not show comparable correlations with either the diurnal PEFR variability or the methacholine threshold (r = 0.09, NS, and r = 0.05, NS, respectively). These results indicate that both baseline lung function and the response to the bronchodilator test correlate with the severity of childhood asthma more appropriately than does the symptom score on a diary card. Since many of these correlations were rather weak, however, the assessment of the severity of childhood asthma cannot be reliably based solely on spirometry in all patients.

The bronchoprotective effect of inhaled salmeterol in preschool children: a dose-ranging study

“…In previous studies, 17±26% of asthmatic children have had decreased MMEF, 29% diagnostic rises in MMEF, 2% decreased PEF, 8% decreased FEV1, and 48% a >20% diurnal variation in PEF [9,12,16,17]. In a recent study from northern Finland, 23% of children had a significant rise in FEV1 and 29% in MMEF values [12]. Thus, our results speak for a good treatment control, better than in most previous studies, in children of all treatment groups.…”

“…The most sensitive variable, MMEF, was decreased in 17%, and it rose significantly in the bronchodilatation test in 10% of the subjects. In previous studies, 17±26% of asthmatic children have had decreased MMEF, 29% diagnostic rises in MMEF, 2% decreased PEF, 8% decreased FEV1, and 48% a >20% diurnal variation in PEF [9,12,16,17]. In a recent study from northern Finland, 23% of children had a significant rise in FEV1 and 29% in MMEF values [12].…”

“…Postbronchodilator PEF and dynamic spirometry measurements were performed after 15 min. In the bronchodilatation test, the limit of positivity was a $15% increase in PEF or FEV1 values, and a 33% or greater increase in MMEF values [8,11,12].…”

The Prevalence of Atopy and Asthma among University Freshmen in Seoul, Korea: Association with Obesity

“…In contrast with challenge tests, BD responsiveness is easily and safely obtained and reliably measured in epidemiologic studies (5,6). A previous study also has indicated that the BD responsiveness is correlated with the severity of asthma (7).…”

Screening for Asthma: Results from a Rural Cohort

“…Smaller airway airflow is reflected in the average forced expiratory flow rate between 25 and 75 percent (FEF 25%-75% ) , which also is called the maximum mid-expiratory flow rate (MMEFR) (Bertka, 2002;Linna, 1996). There is some indication that FEF 25%-75% may be more sensitive in indicating early airway obstruction, particularly in small airways (Lebecque, Kiakulanda, & Coates, 1993;McFadden, & Linden, 1972;Ratageri, Kabra, Lokha, Dwivedi, & Seth, 2001).…”