Role of forced expiratory flow at 25-75% as an early marker of small airways impairment in subjects with allergic rhinitis

Allergy Asthma Proc. 2007 Jan-Feb;28(1):74-8. doi: 10.2500/aap.2007.28.2920.


A close link exists between allergic rhinitis and asthma. Small airway disease (SAD), defined by a reduction in forced expiratory flow at 25-75% of the pulmonary volume (FEF25-75) and normal spirometry (normal forced expiratory volume at 1 second [FEV1], forced vital capacity [FVC], and FEV1/FVC ratio), may be a marker for early allergic or inflammatory involvement of the small airways in subjects with allergic diseases and no asthma. The aim of this study was to determine if there is a relationship between SAD, the outcome variable, and several allergic predictors in patients without asthma but with allergic rhinitis. A cross-sectional study was performed. Two hundred eleven midshipmen attending the third and fifth course of the Navy Academy of Livorno were screened. Fifty-eight midshipmen showed slight spirometric anomalies. Thus, they were referred to the Navy Hospital of La Spezia for standardized tests: skin-prick test, nasal cytology, spirometry, and methacholine bronchial challenge. A reduced FEF(25-75) was arbitrarily defined as < 80% of predicted. All 58 subjects had a normal FEV1, FVC, and FEV1/FVC ratio. Twenty subjects had a reduced FEF(25-75), consistent with the definition of SAD. A mean value of FEF(25-75) of 70.3 (SD, 8.5) was measured in patients with a reduced FEF, and it was 108.0 (SD, 14.3) in patients with preserved FEF(25-75). All the candidate allergic predictors appeared to be strongly associated with a reduced FEF(25-75). The proportion of subjects with reduced FEF(25-75) appeared to increase with increasing severity of the allergic predictors, and, correspondingly, the mean value of FEF(25-75) appeared to decrease. This study provides evidence that there is a relationship between SAD and allergic parameters such as nasal symptoms and eosinophils.

MeSH terms

  • Adult
  • Airway Resistance
  • Bronchial Hyperreactivity / diagnosis
  • Bronchial Hyperreactivity / pathology
  • Bronchial Hyperreactivity / physiopathology*
  • Bronchial Provocation Tests
  • Cross-Sectional Studies
  • Eosinophils / pathology
  • Female
  • Forced Expiratory Volume
  • Humans
  • Italy
  • Male
  • Maximal Midexpiratory Flow Rate*
  • Nasal Mucosa / pathology
  • Predictive Value of Tests
  • Respiratory Hypersensitivity / diagnosis
  • Respiratory Hypersensitivity / pathology
  • Respiratory Hypersensitivity / physiopathology*
  • Respiratory System / pathology
  • Respiratory System / physiopathology*
  • Rhinitis, Allergic, Perennial / pathology
  • Rhinitis, Allergic, Perennial / physiopathology*
  • Rhinitis, Allergic, Seasonal / pathology
  • Rhinitis, Allergic, Seasonal / physiopathology*
  • Severity of Illness Index
  • Skin Tests
  • Spirometry
  • Vital Capacity