Riley, CM and Wenzel, SE and Castro, M and Erzurum, SC and Chung, KF and Fitzpatrick, AM and Gaston, B and Israel, E and Moore, WC and Bleecker, ER and Calhoun, WJ and Jarjour, NN and Busse, WW and Peters, SP and Teague, WG and Sorkness, R and Holguin, F
(2015)
Clinical implications of having reduced mid forced expiratory flow rates (FEF<inf>25-75</inf>), independently of FEV1, in adult patients with asthma.
PLoS ONE, 10 (12).
Abstract
Introduction: FEF25-75 is one of the standard results provided in spirometry reports; however, in adult asthmatics there is limited information on how this physiological measure relates to clinical or biological outcomes independently of the FEV1 or the FEV1/FVC ratio. Purpose: To determine the association between Hankinson's percent-predicted FEF25-75 (FEF25-75%) levels with changes in healthcare utilization, respiratory symptom frequency, and biomarkers of distal airway inflammation. Methods: In participants enrolled in the Severe Asthma Research Program 1-2, we compared outcomes across FEF25-75% quartiles. Multivariable analyses were done to avoid confounding by demographic characteristics, FEV1, and the FEV1/FVC ratio. In a sensitivity analysis, we also compared outcomes across participants with FEF25-75% below the lower limit of normal (LLN) and FEV1/FVC above LLN. Results: Subjects in the lowest FEF25-75% quartile had greater rates of healthcare utilization and higher exhaled nitric oxide and sputum eosinophils. In multivariable analysis, being in the lowest FEF25-75% quartile remained significantly associated with nocturnal symptoms (OR 3.0 [95%CI 1.3-6.9]), persistent symptoms (OR 3.3 [95%CI 1-11], ICU admission for asthma (3.7 [1.3-10.8]) and blood eosinophil % (0.18 [0.07, 0.29]). In the sensitivity analysis, those with FEF25-75% <LLN had significantly more nocturnal and persistent symptoms, emergency room visits, higher serum eosinophil levels and increased methacholine responsiveness. Conclusions: After controlling for demographic variables, FEV1 and FEV1/FVC, a reduced FEF25-75% is independently associated with previous ICU admission, persistent symptoms, nocturnal symptoms, blood eosinophilia and bronchial hyperreactivity. This suggests that in some asthmatics, a reduced FEF25-75% is an independent biomarker for more severe asthma.
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Item Type: |
Article
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Status: |
Published |
Creators/Authors: |
Creators | Email | Pitt Username | ORCID |
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Riley, CM | | | | Wenzel, SE | | | | Castro, M | | | | Erzurum, SC | | | | Chung, KF | | | | Fitzpatrick, AM | | | | Gaston, B | | | | Israel, E | | | | Moore, WC | | | | Bleecker, ER | | | | Calhoun, WJ | | | | Jarjour, NN | | | | Busse, WW | | | | Peters, SP | | | | Teague, WG | | | | Sorkness, R | | | | Holguin, F | | | |
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Contributors: |
Contribution | Contributors Name | Email | Pitt Username | ORCID |
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Editor | Fehrenbach, Heinz | UNSPECIFIED | UNSPECIFIED | UNSPECIFIED |
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Date: |
1 December 2015 |
Date Type: |
Publication |
Access Restriction: |
No restriction; Release the ETD for access worldwide immediately. |
Journal or Publication Title: |
PLoS ONE |
Volume: |
10 |
Number: |
12 |
DOI or Unique Handle: |
10.1371/journal.pone.0145476 |
Institution: |
University of Pittsburgh |
Schools and Programs: |
School of Medicine > Medicine |
Refereed: |
Yes |
Date Deposited: |
23 Aug 2016 14:55 |
Last Modified: |
22 Jun 2021 15:55 |
URI: |
http://d-scholarship.pitt.edu/id/eprint/28323 |
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