Clinical Implications of Having Reduced Mid Forced Expiratory Flow Rates (FEF25-75), Independently of FEV1, in Adult Patients with Asthma
Author
Riley, Craig M.
Wenzel, Sally E.
Castro, Mario
Erzurum, Serpil C.
Chung, Kian Fan
Fitzpatrick, Anne M.
Gaston, Benjamin
Moore, Wendy C.
Bleecker, Eugene R.
Calhoun, William J.
Jarjour, Nizar N.
Busse, William W.
Peters, Stephen P.
Teague, W. Gerald
Sorkness, Ronald
Holguin, Fernando
Published Version
https://doi.org/10.1371/journal.pone.0145476Metadata
Show full item recordCitation
Riley, Craig M., Sally E. Wenzel, Mario Castro, Serpil C. Erzurum, Kian Fan Chung, Anne M. Fitzpatrick, Benjamin Gaston et al. "Clinical Implications of Having Reduced Mid Forced Expiratory Flow Rates (FEF25-75), Independently of FEV1, in Adult Patients with Asthma." PLoS ONE 10, no. 12 (2015): e0145476. DOI: 10.1371/journal.pone.0145476Abstract
IntroductionFEF25-75 is one of the standard results provided in spirometry reports; however, in adult asthmatics there is limited information on how this physiological measure relates to clinical or biological outcomes independently of the FEV1 or the FEV1/FVC ratio.
Purpose
To determine the association between Hankinson’s percent-predicted FEF25-75 (FEF25-75%) levels with changes in healthcare utilization, respiratory symptom frequency, and biomarkers of distal airway inflammation.
Methods
In participants enrolled in the Severe Asthma Research Program 1–2, we compared outcomes across FEF25-75% quartiles. Multivariable analyses were done to avoid confounding by demographic characteristics, FEV1, and the FEV1/FVC ratio. In a sensitivity analysis, we also compared outcomes across participants with FEF25-75% below the lower limit of normal (LLN) and FEV1/FVC above LLN.
Results
Subjects in the lowest FEF25-75% quartile had greater rates of healthcare utilization and higher exhaled nitric oxide and sputum eosinophils. In multivariable analysis, being in the lowest FEF25-75% quartile remained significantly associated with nocturnal symptoms (OR 3.0 [95%CI 1.3–6.9]), persistent symptoms (OR 3.3 [95%CI 1–11], ICU admission for asthma (3.7 [1.3–10.8]) and blood eosinophil % (0.18 [0.07, 0.29]). In the sensitivity analysis, those with FEF25-75% <LLN had significantly more nocturnal and persistent symptoms, emergency room visits, higher serum eosinophil levels and increased methacholine responsiveness.
Conclusions
After controlling for demographic variables, FEV1 and FEV1/FVC, a reduced FEF25-75% is independently associated with previous ICU admission, persistent symptoms, nocturnal symptoms, blood eosinophilia and bronchial hyperreactivity. This suggests that in some asthmatics, a reduced FEF25-75% is an independent biomarker for more severe asthma.
Other Sources
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4696666/Terms of Use
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https://nrs.harvard.edu/URN-3:HUL.INSTREPOS:37372792
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