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. 2006 Nov-Dec;13(8):433-7.
doi: 10.1155/2006/198940.

The American Thoracic Society's spirometric criteria alone is inadequate in asthma diagnosis

John A Gjevre  1 , Thomas S Hurst, Regina M Taylor-Gjevre, Donald W Cockcroft
Affiliations

The American Thoracic Society's spirometric criteria alone is inadequate in asthma diagnosis

John A Gjevre et al. Can Respir J. 2006 Nov-Dec.

Abstract
in English, French

Background: The diagnosis of asthma is based on clinical symptoms, physical examination and pulmonary function tests, and can be very challenging. Most patients with asthma have a significant postbronchodilator response on spirometry indicating airway hyperresponsiveness. However, having a significant bronchodilator response by itself is not diagnostic of asthma. The definition of a 'significant' response has also been controversial. Many respirologists use the American Thoracic Society (ATS) postbronchodilator response criteria of 12% (provided it is 200 mL or greater) improvement in forced expiratory volume in 1 s (or forced vital capacity) from the baseline spirometry.

Methods: In the present study, 644 patients who met the ATS criteria for a significant postbronchodilator spirometric response were retrospectively reviewed. The staff respirologist's diagnosis of asthma, based on all clinical and pulmonary function data, was used as the standard for the diagnosis of asthma.

Results: Relying on spirometric criteria alone was inadequate in asthma diagnosis because only 54.7% of 310 patients who met the ATS bronchodilator response criteria were thought to have clinical asthma. Increasing the postbronchodilator percentage improvement from the ATS criteria only marginally improved diagnostic specificity and resulted in a decline in sensitivity.

Conclusions: The results of the present study further emphasize the need to use spirometric criteria as a guide but not as an unimpeachable gold standard with which to make a diagnosis of asthma. The diagnosis of asthma depends on expert physician correlation of patient history, physical examination and pulmonary function test results.

HISTORIQUE :: Le diagnostic d’asthme se fonde sur les symptômes cli-niques, l’examen physique et les explorations fonctionnelles respiratoires et peut être très complexe. La plupart des patients asthmatiques ont une réponse importante à la spirométrie après l’administration d’un bron-chodilatateur, indicatrice d’une hyperréactivité. Cependant, une réponse importante à l’administration d’un bronchodilatateur ne constitue pas en soi un diagnostic d’asthme. D’ailleurs, la définition de réponse « importante » est controversée. De nombreux pneumologues utilisent les critères d’amélioration du volume expiratoire maximal par seconde (capacité vitale forcée) de 12 % après l’administration d’un bronchodilatateur (pourvu qu’elle soit d’au moins 200 mL) par rapport à la spirométrie de base.

MÉTHODOLOGIE :: Dans la présente étude, 644 patients qui respectaient les critères de réponse importante à la spirométrie après l’administration d’un bronchodilatateur établis par l’ATS ont fait l’objet d’une analyse rétrospective. Le diagnostic d’asthme posé par le pneumologue traitant d’après toutes les données relatives à la fonction clinique et pulmonaire, a été utilisé comme norme pour le diagnostic d’asthme.

RÉSULTATS :: On ne pouvait se fier seulement aux critères spirométriques pour poser un diagnostic d’asthme, parce qu’on pensait que seulement 54,7 % des 310 patients qui respectaient les critères de réponse de l’ATS après l’administration d’un bronchodilatateur étaient atteints d’asthme clinique. Le fait d’accroître le pourcentage d’amélioration après l’administration d’un bronchodilatateur selon les critères de l’ATS n’améliorait que légèrement la spécificité diagnostique et entraînait une diminution de la sensibilité.

CONCLUSIONS :: Les résultats de la présente étude font ressortir davantage la nécessité d’utiliser les critères spirométriques pour orienter le diagnostic, qui ne constituent toutefois pas la norme d’excellence irrécusable pour poser un diagnostic d’asthme. Le diagnostic d’asthme dépend de la corrélation, déterminée par un médecin expert, avec les antécédents du patient, son examen physique et les résultats de l’exploration fonctionnelle respiratoire.

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Figures

Figure 1)
Figure 1)
Total spirometry tests and delineation of patients meeting the study criteria. ATS American Thoracic Society; FEV1 Forced expiratory volume in 1 s; FVC Forced vital capacity
Figure 2)
Figure 2)
Mean percentage improvement in forced expiratory volume in 1 s (FEV1) postbronchodilator in diagnostic groups. Bars show means and error bars show 95% CI of mean. COPD Chronic obstructive pulmonary disease
Figure 3)
Figure 3)
Mean percentage improvement in forced vital capacity (FVC) postbronchodilator in diagnostic groups. Bars show means and error bars show 95% CI of mean. COPD Chronic obstructive pulmonary disease
Figure 4)
Figure 4)
Mean percentage improvement in forced expiratory flow at 25% to 75% (FEF[25%–75%]) postbronchodilator in diagnostic groups. Bars show means and error bars show 95% CI of mean. COPD Chronic obstructive pulmonary disease
Figure 5)
Figure 5)
Receiver-operator characteristic curve. FEV1 Forced expiratory volume in 1 s; FVC Forced vital capacity
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