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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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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
Status: Published
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
ContributionContributors NameEmailPitt UsernameORCID
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


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