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Background: Reduced forced expiratory flow between 25% and 75% of vital capacity percent predicted (FEF%) representing small airway dysfunction (SAD) was associated with asthma development and progression.
Objective: To investigate whether FEF% was superior to forced expiratory volume in 1 second in predicted (FEV%) in reflecting asthma features in adult patients.
Methods: A retrospective spirometry dataset comprising 1801 adult patients with confirmed asthma and a subgroup of 332 patients having detailed clinical data were used to explore the association of FEF% and/or FEV% with clinical features of asthma.
Results: Of the 1801 subjects, FEV% and FEF% ranged from 136.8% to 10.2% and 127.3% to 3.1%, respectively. FEF% < 65% was present in 1,478 (82.07%) of patients. FEF% was strongly correlated with matched FEV% (r = 0.900, P < .001). FEF% and FEV% were both correlated with airway hyperresponsiveness (r = 0.436, P < .001; r = 0.367, P < .001), asthma control test score (r = 0.329, P < .001; r = 0.335, P < .001), and sputum eosinophil count (r = -0.306, P < .001; r = -0.307, P < .001). Receiver-operating characteristic curves showed that FEF% had greater value in predicting severe asthma (area under the curve: 0.84 vs 0.81, P = .018), airflow obstruction (0.97 vs 0.89, P < .001), and severe bronchial hyperresponsiveness (0.74 vs 0.69, P = .012) as compared with FEV%. Patients with SAD (FEF% < 65%) in the presence of normal FEV% exhibited higher sputum eosinophil counts and had an increased dosage of daily inhaled corticosteroids (P < .001 and P = .010) than patients with normal lung function and their FEF% values correlated with sputum eosinophil count (r = -0.419, P = .015), but not FEV%.
Conclusion: FEF% represented small airway function and was more sensitive at reflecting airway hyperresponsiveness, inflammation, and disease severity as compared with FEV% in patients with asthma. Our data suggest further assessment of FEF% in asthma management, particularly for those with SAD who present normal FEV%.
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| http://dx.doi.org/10.1016/j.jaip.2021.06.027 | DOI Listing |
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