Tuberc Respir Dis.  2011 Sep;71(3):188-194.

Prediction of Brobchodilator Response by Using FEF25~75% in Adult Patient with a Normal Spirometry Result

• Park SH
• Lee SY
• Kang SM
• Seon CS
• Kim HK
• Lee BH
• Lee JH
• Kim SH

Abstract

BACKGROUND
When patients with chronic respiratory symptoms have a normal spirometry result, it is not always easy to consider bronchial asthma as the preferential diagnosis. Forced expiratory flow between 25% and 75% of vital capacity (FEF(25~75%)) is known as a useful diagnostic value of small airway diseases. However, it is not commonly used, because of its high individual variability. We evaluated the pattern of bronchodilator responsiveness (BDR) and the correlation between FEF25~75% and BDR in patients with suspicious asthma and normal spirometry.
METHODS
Among patients with suspicious bronchial asthma, 440 adult patients with a normal spirometry result (forced expiratory volume in one second [FEV1]/forced vital capacity [FVC] > or =70% & FEV1% predicted > or =80%) were enrolled. We divided this group into a positive BDR group (n=43) and negative BDR group (n=397), based on the result of BDR. A comparison was carried out of spirometric parameters with % change of FEV1 after bronchodilator (DeltaFEV1%).
RESULTS
Among the 440 patients with normal spirometry, FEF(25~75%)% predicted were negatively correlated with DeltaFEV1% (r=-0.22, p<0.01), and BDR was positive in 43 patients (9.78%). The means of FEF(25~75%)% predicted were 64.0+/-14.5% in the BDR (+) group and 72.9+/-20.8% in the BDR (-) group (p<0.01). The negative correlation between FEF(25~75%)% predicted and DeltaFEV1% was stronger in the BDR (+) group (r=-0.38, p=0.01) than in the BDR (-) group (r=-0.17, p<0.01). In the ROC curve analysis, FEF(25~75%) at 75% of predicted value had 88.3% sensitivity and 40.3% specificity for detecting a positive BDR.
CONCLUSION
BDR (+) was not rare in patients with suspicious asthma and normal spirometry. In these patients, FEF(25~75%)% predicted was well correlated with BDR.

Keyword

Bronchodilator Agents; Asthma

MeSH Terms

Adult
Asthma
Bronchodilator Agents
Humans
ROC Curve
Spirometry
Vital Capacity
Bronchodilator Agents

Figure

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  Figure 1 (A) Correlation between % change of FEV1 after bronchodilator (ΔFEV1%) and FEF25~75%% predicted value in total patients with suspicious asthma and normal spirometry (r=-0.22, p<0.01) and (B) correlation between ΔFEV1% and FEV1/FVC in total patients with suspicious asthma and normal spirometry (r=-0.18, p<0.01). Among 43 patients with positive bronchodilator response (ΔFEV1% ≥12%), the number of patients with FEF25~75% more than 80% predicted value is four and that of patients with FEV1/FVC more than 80% is seven. FVC: forced vital capacity; FEV1: forced expiratory volume in one second; FEF25~75%: forced expiratory flow between 25 and 75% of vital capacity.

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  Figure 2 (A) ROC curve of FEF25~75%% predicted for bronchodilator responsiveness as a change of more than 12% and 200 mL in FEV1 (p<0.01) and (B) ROC curve of FEV1/FVC for bronchodilator responsiveness as a change of more than 12% and 200 mL in FEV1 (p=0.03). The inflection value for FEF25~75% is at 75% of predicted value and that for the FEV1/FVC ratio is at 79% of predicted value. ROC: receiver operating characteristic; AUC: area under curve; FEF25~75%: forced expiratory flow between 25 and 75% of vital capacity; FVC: forced vital capacity; FEV1: forced expiratory volume in one second.

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