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. 2023 Apr;68(4):505-510.
doi: 10.4187/respcare.10177.

Bronchodilator Response in FEF25-75 for the Diagnosis of Asthma in Children

Marcela B Linares  1 , María Angelica Rodríguez  2 , Danae M Icarte  3 , Bitter A Martínez  4 , Valentina P Milla  5 , Noelia F Zygier  6 , Claudio R Olmos  7
Affiliations

Bronchodilator Response in FEF25-75 for the Diagnosis of Asthma in Children

Marcela B Linares et al. Respir Care. 2023 Apr.

Abstract

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.

Keywords: asthma; bronchial hyper-responsiveness; bronchodilator; child; exercise test; methacholine; spirometry.

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Conflict of interest statement

The authors have disclosed no conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Flow chart. MCT = methacholine test; BDR = bronchodilator response.
Fig. 2.
Fig. 2.
Positive results in the methacholine test and/or the exercise test compared between the groups according to change in FEF25–75 in response to the bronchodilator. When applying the chi-square test, it was found that the differences observed were statistically significant between both groups (P = .039). PC20 = methacholine concentration that causes a 20% drop in FEV1 compared to baseline; BDR = bronchodilator response.
See this image and copyright information in PMC

References

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