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

Se Hwan Park; Seung Yup Lee; Seung Mo Kang; Choon Sik Seon; Hyun Kyung Kim; Byoung Hoon Lee; Jae Hyung Lee; Sang Hoon Kim

doi:10.4046/trd.2011.71.3.188

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Park, Lee, Kang, Seon, Kim, Lee, Lee, and Kim: Prediction of Brobchodilator Response by Using FEF25~75% in Adult Patient with a Normal Spirometry Result

Original Article

Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2011; 71(3): 188-194.

Published online: 30 September 2011

DOI: https://doi.org/10.4046/trd.2011.71.3.188

Prediction of Brobchodilator Response by Using FEF_25~75% in Adult Patient with a Normal Spirometry Result

Se Hwan Park, M.D., Seung Yup Lee, M.D., Seung Mo Kang, M.D., Choon Sik Seon, M.D., Hyun Kyung Kim, M.D., Byoung Hoon Lee, Ph.D., Jae Hyung Lee, Ph.D., Sang Hoon Kim, Ph.D.

Division of Pulmology and Allergy, Department of Internal Medicine, Eulji Medical Center, Eulji University School of Medicine, Korea.

Address for correspondence: Byoung Hoon Lee, Ph.D. Division of Pulmology and Allergy, Department of Internal Medicine, Eulji Medical Center, Eulji University School of Medicine, 208-1, Hagye 1-dong, Nowon-gu, Seoul 139-711, Korea. Phone: 82-2-970-8625, Fax: 82-2-975-4630, hoonakr@eulji.ac.kr

Received 13 May 2011 Accepted 3 August 2011

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 FEF_25~75% 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] ≥70% & FEV₁% predicted ≥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 (ΔFEV₁%).

Results

Among the 440 patients with normal spirometry, FEF_25~75%% predicted were negatively correlated with ΔFEV₁% (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 ΔFEV₁% 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.

Keywords: Bronchodilator Agents, Asthma

Figures and Tables

Figure 1

(A) Correlation between % change of FEV1 after bronchodilator (ΔFEV¹%) and FEF_25~75%% 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 FEF_25~75% 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; FEF_25~75%: forced expiratory flow between 25 and 75% of vital capacity.

Figure 2

(A) ROC curve of FEF_25~75%% 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 FEF_25~75% 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; FEF_25~75%: forced expiratory flow between 25 and 75% of vital capacity; FVC: forced vital capacity; FEV₁: forced expiratory volume in one second.

Table 1

General characteristics and pulmonary function test of patients

^*p-value between BDR positive and BDR negative, ^†Percent changes of FEV₁ after bronchodilator inhalation.

BDR: bronchodilator response; FVC: forced vital capacity; FEV₁: forced expiratory volume in one second.

Table 2

Correlations between ΔFEV₁% and other spirometric values

^*Percent changes of FEV₁ after bronchodilator inhalation.

BDR: bronchodilator response; FVC: forced vital capacity; FEV₁: forced expiratory volume in one second.

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