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TEV/FEV₃ as a coherent metric of small airway dysfunction in childhood asthma

Authors
 Jae Hwa Jung  ;  Mireu Park  ;  Ga Eun Kim  ;  Jong Deok Kim  ;  Min Jung Kim  ;  Sun Ha Choi  ;  Yoon Hee Kim  ;  Myung Hyun Sohn  ;  Soo Yeon Kim  ;  Kyung Won Kim 
Citation
 ALLERGY AND ASTHMA PROCEEDINGS, Vol.44(3) : 171-178, 2023-05 
Journal Title
ALLERGY AND ASTHMA PROCEEDINGS
ISSN
 1088-5412 
Issue Date
2023-05
MeSH
Asthma* / diagnosis ; Child ; Child, Preschool ; Humans ; Reproducibility of Results ; Respiratory Function Tests ; Retrospective Studies ; Spirometry
Abstract
Background: Spirometry is an unrivalled tool for determining asthma and asthma severity. The ratio of forced expiratory volume (FEV) in 1 second (FEV1) to forced vital capacity (FVC) and the forced expiratory flow between 25% and 75% of FVC (FEF25-75) are well-known markers of airway obstruction, but they are limited by low reproducibility, particularly in children. In this study, we defined terminal expiration volume (TEV) as FEV in 3 seconds forced expiratory volume in 3 seconds (FEV₃) minus forced expiratory volume in 1 seconds (FEV1) and investigate whether TEV/FEV₃ can function as a coherent marker to compensate for existing markers.
Methods: This retrospective study comprised 980 children ages ≤ 18 years who underwent spirometry and the bronchial provocation testing. TEV/FEV₃ was compared with regard to asthma presence and severity. The findings were verified with an external validation group (n = 105).
Results: FEV₃ was obtained in 837 children (85.4%). TEV/FEV₃ was significantly higher in patients with asthma than in patients who did not have asthma (17.1 ± 5.5 versus 12.0 ± 4.4, p < 0.001). External validation with 73 patients showed similar results (18.0 ± 5.9 in asthma versus 10.2 ± 5.1 in non-asthma, p < 0.001). The discriminatory power of TEV/FEV₃ for asthma was comparable with that of FEF25-75 (p = 0.804). TEV/FEV₃ significantly increased with asthma severity (mild, 16.1 ± 5.4; moderate, 17.7 ± 5.4; severe, 22.0 ± 5.3; p < 0.001). For patients who could not achieve FEV₃, FEF25-75 demonstrated no significant difference between mild and moderate asthma, and could not discriminate asthma or asthma severity.
Conclusion: TEV/FEV₃ is a new metric that may help diagnose and determine asthma severity by using conventional spirometry by assessing small airway dysfunction. TEV/FEV₃ promotes a reassessment of the reliability of other spirometric parameters, particularly in young children. Caution is needed in interpreting the result of spirometry in children who cannot achieve FEV₃.
Full Text
https://www.ingentaconnect.com/content/ocean/aap/2023/00000044/00000003/art00004
DOI
10.2500/aap.2023.44.230008
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Pediatrics (소아과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Kyung Won(김경원) ORCID logo https://orcid.org/0000-0003-4529-6135
Kim, Min Jung(김민정) ORCID logo https://orcid.org/0000-0002-5634-9709
Kim, Soo Yeon(김수연) ORCID logo https://orcid.org/0000-0003-4965-6193
Kim, Yoon Hee(김윤희) ORCID logo https://orcid.org/0000-0002-2149-8501
Kim, Jong Deok(김종덕)
Park, Mireu(박미르)
Sohn, Myung Hyun(손명현) ORCID logo https://orcid.org/0000-0002-2478-487X
Jung, Jae Hwa(정재화)
Choi, Sun Ha(최선하)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/196727
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