Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.
Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.
Eur Respir J. 2019 Feb 14;53(2). doi: 10.1183/13993003.00904-2018. Print 2019 Feb.
Asthma is characterised by variable and reversible expiratory airflow limitations. Thus, it is logical to use the change in forced expiratory volume in 1 s (FEV) in response to a bronchodilator (ΔFEVBDR) as a diagnostic tool; increases of ≥12% and ≥200 mL from the baseline FEV are commonly used values. We aimed to evaluate the historical development of diagnostic cut-off levels for the ΔFEVBDR for adults and the evidence behind these recommendations.We searched for studies from the reference lists of all the main statements, reports and guidelines concerning the interpretation of spirometry and diagnostics for asthma and conducted a literature search.A limited amount of evidence regarding the ΔFEVBDR in healthy populations was found, and even fewer patient studies were found. In healthy persons, the upper 95th percentile for the absolute ΔFEVBDR ranges between 240 mL and 320 mL, the relative ΔFEVBDR calculated from the initial FEV ranges from 5.9% to 13.3% and the ΔFEVBDR calculated from the predicted FEV ranges from 8.7% to 11.6%. However, the absolute and percentage ΔFEVBDR values calculated from the initial FEV are dependent on age, sex, height and the degree of airway obstruction. Thus, the use of the ΔFEVBDR calculated from the predicted FEV might be more appropriate.Not enough data exist to assess the sensitivity of any of the cut-off levels for the ΔFEVBDR to differentiate asthma patients from healthy subjects. Further studies in newly diagnosed asthma patients are needed.
哮喘的特征是呼气气流受限具有可变性和可逆性。因此，使用支气管扩张剂后用力呼气量 1 秒（FEV1）的变化（ΔFEVBDR）作为诊断工具是合理的；常用的诊断界值为基线 FEV1 增加≥12%和≥200 mL。我们旨在评估成人 ΔFEVBDR 的诊断界值的历史发展以及这些推荐背后的证据。我们从所有有关肺功能测定和哮喘诊断解释的主要声明、报告和指南的参考文献中搜索了研究，并进行了文献检索。我们仅发现了有限数量的关于健康人群中 ΔFEVBDR 的证据，而且针对患者的研究更少。在健康人群中，绝对 ΔFEVBDR 的第 95 个上限值范围在 240-320 mL 之间，从初始 FEV 计算的相对 ΔFEVBDR 范围在 5.9%-13.3%之间，从预测 FEV 计算的 ΔFEVBDR 范围在 8.7%-11.6%之间。然而，从初始 FEV 计算的绝对和百分比 ΔFEVBDR 值取决于年龄、性别、身高和气道阻塞程度。因此，使用从预测 FEV 计算的 ΔFEVBDR 可能更合适。目前尚无足够的数据来评估任何 ΔFEVBDR 诊断界值区分哮喘患者和健康受试者的敏感性。需要对新诊断的哮喘患者进行进一步研究。
