Spirometric Changes in Bronchodilation Tests as Predictors of Asthma Diagnosis and Treatment Response in Patients with FEV1 ≥ 80% Predicted

Huijuan Hao; Wuping Bao; Yishu Xue; Yan Zhou; Zhixuan Huang; Dongning Yin; Yingying Zhang; Pengyu Zhang; Chengjian Lv; Lei Han; Xin Zhou; Junfeng Yin; Min Zhang

doi:10.1016/j.jaip.2021.03.015

Spirometric Changes in Bronchodilation Tests as Predictors of Asthma Diagnosis and Treatment Response in Patients with FEV₁ ≥ 80% Predicted

J Allergy Clin Immunol Pract. 2021 Aug;9(8):3098-3108.e4. doi: 10.1016/j.jaip.2021.03.015. Epub 2021 Mar 23.

Authors

Affiliations

¹ Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China.
² School of Mathematical Sciences, Tongji University, Shanghai, China.
³ Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China. Electronic address: maggie_zhangmin@163.com.

PMID: 33766580
DOI: 10.1016/j.jaip.2021.03.015

Abstract

Background: Many patients with mild asthma are undiagnosed and untreated due to the low diagnostic sensitivity of bronchodilation test (BDT).

Objective: To investigate whether airway reversibility in BDT and fractional exhaled nitric oxide (Feno) can predict the response to antiasthma therapy (RAT) in patients with suspected asthma.

Methods: This open-label, prospective cohort study included patients with chronic recurrent asthma symptoms, normal FEV₁, and negative BDT results. Inhaled corticosteroids and long-acting β agonists were given for 4 weeks. A positive RAT was defined as improved symptoms and an increase of more than 200 mL in FEV₁ after inhaled corticosteroid/long-acting β agonist treatment. Lung tissues from another 19 patients who underwent pneumectomy for lung nodules were also analyzed.

Results: Of 110 patients recruited, 102 completed the study. Patients in the positive RAT group had a higher Feno and greater absolute (Δ) and percent (Δ%) improvements in forced vital capacity, FEV₁, and forced expiratory flows (FEFs) in BDT than in the negative RAT group. The area under the curves of Feno, ΔFEV₁%, ΔFEF_25-75% (percent improvement in FEF at 25%-75% of forced vital capacity), and ΔFEF₇₅% (percent improvement in FEF at 75% of forced vital capacity) for positive RAT were 0.703, 0.824, 0.736, and 0.710, with cutoff values of 33 parts per billion and 3.50%, 15.26%, and 26.04%, respectively. A joint model of Feno and ΔFEV₁% increased the area under the curve to 0.880. Inflammatory cytokines were higher in the lung tissues of patients with predicted positive RAT than in those with predicted negative RAT.

Conclusions: ΔFEV₁% in BDT together with Feno predicted a positive RAT and an asthma diagnosis in patients with a normal FEV₁ and negative BDT. Evidence of pathological changes increases the credibility of the predictive model.

Keywords: Bronchodilation tests; FEV(1); Forced expiratory flows; Fractional exhaled nitric oxide; Pathology.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Asthma* / diagnosis
Asthma* / drug therapy
Breath Tests
Forced Expiratory Volume
Humans
Nitric Oxide
Prospective Studies
Respiratory Function Tests
Spirometry

Substances

Nitric Oxide