The value of small airway function parameters and fractional exhaled nitric oxide for predicting positive methacholine challenge test in asthmatics of different ages with FEV₁ ≥ 80% predicted

Abstract

Background Small airway function parameters (SAFPs) combined with fractional exhaled nitric oxide (FeNO) can predict a positive methacholine challenge test (MCT) for asthma diagnosis. However, their predictive utility in patients with forced expiratory volume in one second (FEV1) ≥80% predicted within different age ranges remains unclear. This study aimed to assess the utility of SAFPs, alone or combined with FeNO, to predict a positive MCT in patients in two age groups (<55 and ≥55 years) with asthma‐suggestive symptoms and FEV1 ≥80% predicted. Methods We enrolled 846 Chinese patients with suspected asthma and standard spirometry, FeNO, and MCT findings. Using the area under the curves (AUCs), the utility of SAFPs, alone or combined with FeNO, for predicting a positive MCT was analyzed in a discovery (n = 534) and validation cohort (n = 312) in both age groups with FEV1 ≥80% predicted. Results In the discovery cohort, the optimal cut‐off values for predicting a positive MCT in patients aged <55 years (74.2% and 74.9% for forced expiratory flow (FEF)50% and FEF25%–75%, respectively) were higher than those in patients aged ≥55 years (65.0% and 62.9% for FEF50%, FEF25%–75%, respectively). However, the optimal FeNO value in patients aged <55 years (43 ppb) was lower than that in patients aged ≥55 years (48 ppb). FeNO combined with SAFPs (FEF50%, FEF25%–75%) significantly increased the AUCs in both groups (≥55 years [0.851 for FEF50% and 0.844 for FEF25%–75%]; <55 years [0.865 for FEF50% and 0.883 for FEF25%–75%]) compared with a single parameter (p < 0.05). These findings were confirmed in the validation cohort. Compared with patients ≥55 years, those aged <55 years had higher and lower optimal cut‐off values for SAFPs and FeNO, respectively. The AUCs of FeNO combined with SAFPs for predicting a positive MCT for asthma diagnosis were significantly higher than those of the individual parameters (p < 0.05) in both age groups. Conclusions There were age‐group differences in the utility of SAFPs combined with FeNO for predicting a positive MCT. Patients with an asthma‐suggestive history and a normal FEV1 should be stratified by age when using SAFPs combined with FeNO to predict a positive MCT.

Small Airways: The “Silent Zone” of 2021 GINA Report?

“…In all of these studies, asthma control was intimately related to SAD and clinical phenotypes associated with SAD, and notably the IOS has better associations than spirometry, supporting the importance of using IOS and more modern tools in addition to spirometry. Studies supporting the relationship between asthma control and severity, asthma features, and SAD ( 18 – 28 , 30 – 63 ) are summarized in Figure 1 .…”

Correlation between Reduced FEF25-75% and a Positive Methacholine Challenge Test in Adults with Nonobstructive Baseline Spirometry

“…Combining these two values gave an area under the curve (AUC) of 0.865 (95% CI: 0.833-0.893). They observed that the optimal cut-off for predicting a positive methacholine results to be FEF25-75% of less than 74.9% predicted in patients younger than 55 years of age and less than 62.9% in patients > 55 years of age [ 19 ].…”

Transcriptome analysis in patients with asthma after inhaled combination therapy with long-acting β2-agonists and corticosteroids

“…MCT was performed using a nebulizer with methacholine doses, and forced expiratory volume (FEV1) was measured 5 min after each provocation step. Provocative doses that caused a 20% decrease in FEV 1 were recorded as PD 20 [4].…”