运动激发试验：FEV₁下降15%足以用于诊断吗？

Exercise challenge test: is a 15% fall in FEV(1) sufficient for diagnosis?

作者信息

Fuentes Claudia, Contreras Stefani, Padilla Oslando, Castro-Rodriguez Jose A, Moya Ana, Caussade Solange

机构信息

Pediatric Division, Respiratory Section, Pontificia Universidad Católica de Chile, Santiago, Chile.

出版信息

J Asthma. 2011 Sep;48(7):729-35. doi: 10.3109/02770903.2011.594139. Epub 2011 Jul 13.

DOI:10.3109/02770903.2011.594139

PMID:21749286

Abstract

INTRODUCTION

In the exercise challenge test (ECT), a drop in forced expiratory volume in the first second (FEV(1)) of between 10 and 15% is the determinant variable for a diagnosis of exercise-induced bronchospasm.

HYPOTHESIS

The use of FEV(1) plus mean forced expiratory flow between 25% and 75% of the forced vital capacity (FEF(25-75%)) may increase the sensitivity of the ECT in asthmatic children.

SPECIFIC OBJECTIVE

To compare FEV(1) and FEF(25-75%) changes in a group of asthmatic and healthy children.

METHODOLOGY

This was a cross-sectional study. Asthmatics were categorized by their severity (GINA) and after 1 month without controller therapy, an ECT was done under standard protocol. As well, a questionnaire about rhinitis and asthma was conducted with the entire population. ROC curves were used for analysis.

RESULTS

A total of 147 children (34 healthy and 113 asthmatics, 18 and 58 males, respectively) were evaluated. Divided into healthy children and intermittent, mild and moderate persistent asthmatics, they had similar average ages (9.4, 9.48, 8.97, and 11.2 years, respectively). Using a 15% fall in FEV(1), we obtained 29% sensitivity and 100% specificity. However, when we used a 10% fall in FEV(1), sensitivity was 47% and specificity was 97%. Adding a 28% fall in FEF(25-75%), sensitivity was 52% and specificity was 94%.

CONCLUSION

This study suggests that test sensitivity can increase by using a lower FEV(1) cut-off (10%) and adding a 28% fall in FEF(25-75%).

摘要

引言

在运动激发试验（ECT）中，第一秒用力呼气量（FEV(1)）下降10%至15%是诊断运动诱发性支气管痉挛的决定性变量。

假设

使用FEV(1)加上用力肺活量25%至75%之间的平均用力呼气流量（FEF(25 - 75%)）可能会提高ECT对哮喘儿童的敏感性。

具体目标

比较一组哮喘儿童和健康儿童的FEV(1)和FEF(25 - 75%)变化。

方法

这是一项横断面研究。根据哮喘严重程度（全球哮喘防治创议（GINA））对哮喘患者进行分类，在停用控制药物1个月后，按照标准方案进行ECT。此外，还对所有受试者进行了关于鼻炎和哮喘的问卷调查。采用ROC曲线进行分析。

结果

共评估了147名儿童（34名健康儿童和113名哮喘儿童，分别有18名和58名男性）。分为健康儿童、间歇性、轻度和中度持续性哮喘患者，他们的平均年龄相似（分别为9.4岁、9.48岁、8.97岁和11.2岁）。FEV(1)下降15%时，敏感性为29%，特异性为100%。然而，当FEV(1)下降10%时，敏感性为47%，特异性为97%。加上FEF(25 - 75%)下降28%时，敏感性为52%，特异性为94%。