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Clinical implications of having reduced mid forced expiratory flow rates (FEF <inf>25-75</inf> ), independently of FEV1, in adult patients with asthma

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).

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Abstract

© 2015 Riley et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Introduction: FEF 25-75 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 FEV 1 or the FEV 1 /FVC ratio. Purpose: To determine the association between Hankinson's percent-predicted FEF 25-75 (FEF 25-75 %) 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 FEF 25-75 % quartiles. Multivariable analyses were done to avoid confounding by demographic characteristics, FEV 1 , and the FEV 1 /FVC ratio. In a sensitivity analysis, we also compared outcomes across participants with FEF 25-75 % below the lower limit of normal (LLN) and FEV 1 /FVC above LLN. Results: Subjects in the lowest FEF 25-75 % quartile had greater rates of healthcare utilization and higher exhaled nitric oxide and sputum eosinophils. In multivariable analysis, being in the lowest FEF 25-75 % 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 FEF 25-75 % <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, FEV 1 and FEV 1 /FVC, a reduced FEF 25-75 % is independently associated with previous ICU admission, persistent symptoms, nocturnal symptoms, blood eosinophilia and bronchial hyperreactivity. This suggests that in some asthmatics, a reduced FEF 25-75 % is an independent biomarker for more severe asthma.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
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
Contributors:
ContributionContributors NameEmailPitt UsernameORCID
EditorFehrenbach, HeinzUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
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: 15 Apr 2019 14:55
URI: http://d-scholarship.pitt.edu/id/eprint/28323

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