Bronchodilator Response in FEF25–75 for the Diagnosis of Asthma in Children
Bronchodilator Response in FEF25–75 for the Diagnosis of Asthma in Children
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FEF25-75 中的支气管扩张剂反应用于诊断儿童哮喘
DOI：
10.4187/respcare.10177
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发表时间：
2023
期刊：
影响因子：
2.5
通讯作者：
Claudio R Olmos
中科院分区：
文献类型：
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作者：
Marcela B Linares;María Angelica Rodríguez;Danae M Icarte;Bitter A Martínez;Valentina P Milla;Noelia F Zygier;Claudio R Olmos
背景：肺活量测定测试中 FEV1 的支气管扩张反应 (BDR)、使 FEV1 (PC20) 下降 20% 的乙酰甲胆碱浓度≤ 2 mg/mL，以及阳性运动测试对于诊断儿童哮喘具有高度特异性。然而，肺活量测定中用力肺活量操作 (FEF25-75) 的中半段用力呼气流量的值受到质疑。本研究的目的是将 FEV1 和 FEV1/FVC 正常的肺活量测定的 FEF25-75 中的 BDR 与临床怀疑患有哮喘的 5-15 岁儿童对乙酰甲胆碱或运动的气道高反应性 (AHR) 联系起来。方法：这是一项对 2017 年 1 月至 2019 年 12 月期间对诊断怀疑患有哮喘的 5 岁至 15 岁儿童进行的肺活量测定测试的横断面研究，这些儿童在两次检查之间不超过 60 天的时间内进行了乙酰甲胆碱和/或运动测试。结果：儿童平均年龄（±SD）为9.04±2.67岁，范围为5~15岁，其中56.17%为男性。在 324 次 FEV1 和 FEV1/FVC 正常的肺活量测定中，66 次 (20.4%) 测试显示 BDR 在 FEF25-75 之间。 FEF25-75 中患有和不患有 BDR 的儿童中，PC20 值 ≤ 2 mg/mL 和/或运动测试呈阳性的比例分别为 46.9% 和 33.3% (P = .039)。结论：疑似哮喘且肺量测定正常的儿童，除了 FEF25-75 中的 BDR 之外，其 AHR 高于 FEF25-75 中没有 BDR 的儿童。 FEF25-75 中的 BDR 并不总是伴随 AHR 来确认哮喘的诊断，因此本研究表明，在疑似哮喘儿童的肺量测定结果正常的情况下，单独评估 FEF25-75 并不总是可靠地排除或排除 AHR。
BACKGROUND: Spirometry tests with a bronchodilator response (BDR) in FEV1, a methacholine concentration that produces a 20% drop in FEV1 (PC20) ≤ 2 mg/mL, and a positive exercise test have high specificity for the diagnosis of asthma in children. However, the value of forced expiratory flow during the middle half of the FVC maneuver (FEF25–75) in spirometry has been questioned. The objective of this study was to relate the BDR in FEF25–75 of spirometry tests with normal FEV1 and FEV1/FVC to airway hyper-responsiveness (AHR) to methacholine or exercise in children age 5–15 y with clinical suspicion of asthma. METHODS: This was a cross-sectional study of spirometry tests performed between January 2017–December 2019 in children age 5–15 y with diagnostic suspicion of asthma who had a methacholine and/or exercise testing within a period not exceeding 60 d between exams. RESULTS: The mean (± SD) age of the children was 9.04 ± 2.67 y, with a range of 5–15 y, and 56.17% were male. Of the 324 spirometry tests with normal FEV1 and FEV1/FVC, 66 (20.4%) tests showed BDR in FEF25–75. A total of 46.9% and 33.3% of the children with and without BDR in FEF25–75, respectively, had a PC20 value ≤ 2 mg/mL and/or a positive exercise testing (P = .039). CONCLUSIONS: Children with suspected asthma and normal spirometry, other than BDR in FEF25–75, had greater AHR than those without BDR in FEF25–75. BDR in FEF25–75 was not always accompanied by AHR to confirm the diagnosis of asthma, so this study suggests that assessment of FEF25–75 alone is not always reliable for ruling in or ruling out AHR in the setting of otherwise normal spirometry results in children with suspected asthma.