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Sposato B, Scalese M, Migliorini MG, et al. Small airway impairment and bronchial hyperresponsiveness in asthma onset. Allergy Asthma Immunol Res. 2014;6(3):242-51doi: 10.4168/aair.2014.6.3.242.
Sposato, B., Scalese, M., Migliorini, M. G., Di Tomassi, M., & Scala, R. (2014). Small airway impairment and bronchial hyperresponsiveness in asthma onset. Allergy, asthma & immunology research, 6(3), 242-51. https://doi.org/10.4168/aair.2014.6.3.242
Sposato, Bruno, et al. "Small airway impairment and bronchial hyperresponsiveness in asthma onset." Allergy, asthma & immunology research vol. 6,3 (2014): 242-51. doi: https://doi.org/10.4168/aair.2014.6.3.242
Sposato B, Scalese M, Migliorini MG, Di Tomassi M, Scala R. Small airway impairment and bronchial hyperresponsiveness in asthma onset. Allergy Asthma Immunol Res. 2014 May;6(3):242-51. doi: 10.4168/aair.2014.6.3.242. Epub 2014 Feb 11. PMID: 24843800; PMCID: PMC4021243.
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Allergy Asthma Immunol Res. 2014 May;6(3):242-51. doi: 10.4168/aair.2014.6.3.242. Epub 2014 Feb 11.

Small airway impairment and bronchial hyperresponsiveness in asthma onset.

Allergy, asthma & immunology research

Bruno Sposato, Marco Scalese, Maria Giovanna Migliorini, Maurizio Di Tomassi, Raffaele Scala

Affiliations

  1. Unit of Pneumology, "Misericordia" Hospital, Grosseto, Italy.
  2. Institute of Clinical Physiology, National Research Council (CNR), Pisa, Italy.
  3. Unit of Pneumology and UTIP, "S.Donato" Hospital, Arezzo, Italy.

PMID: 24843800 PMCID: PMC4021243 DOI: 10.4168/aair.2014.6.3.242

Abstract

PURPOSE: Our study tried to find a relationship between baseline FEF25-75% and airway hyperresponsiveness (AHR) and whether a greater FEF25-75% impairment may be a marker of a more severe hyperresponsiveness in subjects with normal FEV1 and FEV1/FVC and suggestive asthma symptoms. Besides, we tried to asses a FEF25-75% cut-off value to identify hyper-reactive subjects.

METHODS: 4,172 subjects (2,042 M; mean age: 38.3±14.9; mean FEV1 % predicted: 100.5±12.7 and FEV1/FVC: 85.4±6.8) were examined after performing a methacholine (Mch) test. All subjects reported a symptom onset within 3 years before the test. Subjects with PD20<400 or >400 µg were arbitrarily considered affected by moderate/severe and borderline AHR, respectively.

RESULTS: PD20 values were 213 (IQR:86-557), 340 (IQR:157-872) and 433 (IQR:196-1032) µg in subjects with baseline FEF25-75≤50%, FEF25-75 between 50 and 70% and FEF25-75>70% respectively (P<0.0001). Only in moderate/severe hyper-reactive subjects (excluded borderlines), PD20 was lower in the FEF25-75≤50% subgroup than in the 1 with FEF25-75>70%. The hyperreactive subjects percentage, was higher in those with FEF25-75≤50% and lower in those with FEF25-75>70% (P<0.0001). FEF25-75<50% (compared to FEF25-75>70%) was a higher AHR risk factor, especially in subjects with moderate/severe AHR (OR: 2.18 [IQR:1.41-3.37]; P<0.0001). Thresholds yielding the highest combined sensitivity/specificity for FEF25-75% were 75.19 (area under curve [AUC]: 0.653) and 74.95 (AUC:0.688) in subjects with PD20<2,400 and <400 µg respectively. FEV1, FVC, and FEV1/FVC measured in subjects with different FEF25-75≤50%, FEF25-75>50 and ≤70% or FEF25-75>70% levels were similar both in normoreactive and hyperreactive subjects.

CONCLUSIONS: At asthma onset, reduced baseline FEF25-75 values with normal FEV1 and FEV1/FVC may predict AHR. Detectable predictive cut-off values do not exist because even normoreactive subjects can show lower FEF25-75 values. Furthermore, a greater FEF25-75 reduction may be associated to a more severe AHR, suggesting a possible FEF25-75 role in the management of asthma when FEV1 and FEV1/FVC are normal.

Keywords: Airway hyperresponsiveness; FEF25-75; asthma; diagnosis; methacholine test; small airways

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