Department for Children and Adolescents, Allergy, Pulmonology, and Cystic Fibrosis, University Hospital Frankfurt, Goethe University, Germany.
Research in Respiratory Diagnostics, Berlin, Germany.
Respir Med. 2019 Mar;148:54-59. doi: 10.1016/j.rmed.2019.01.011. Epub 2019 Jan 29.
The exercise challenge is the gold standard for diagnosing exercise-induced bronchoconstriction (EIB). Airway obstructions appear up to 30 min after the challenge, with a maximum decrease in spirometry and a maximum increase in airway resistance. There is evidence that changes in body plethysmography parameters are more sensitive to the exercise challenge and precede those in spirometry.
To compare changes in body plethysmography and spirometry parameters after exercise challenges and to verify the cut-off values of sReff in EIB.
In 82 subjects with suspected EIB, a total of 473 lung function tests were measured at baseline and at 5, 10, 15, and 30 min after exercise challenges at different stages of bronchial obstruction.
The maximum changes in the body plethysmography parameter sReff significantly preceded the maximum changes in the spirometry parameter FEV (sReff: 12.2 min ±8.8, FEV: 15.2 min ±9.3, p < 0.005). The parameters of sReff and FEV had a strong negative correlation (r = -0.63, p < 0.0001) with a nonlinear, polynomial relationship. Furthermore, sReff and Reff had a strong linear correlation (r = 0.86, p < 0.001), and Reff and Rtot had a perfect linear correlation (r = 0.99, p < 0.001). Based on baseline values and on quantile regression, an increase of 0.25 kPa s in sReff was defined as significant. Using this cut-off value, FEV and sReff almost equally detected EIB.
The changes in sReff were more sensitive and better indicated lung impairment than did the changes in FEV, which underestimated the degree of hyperinflation.
运动挑战是诊断运动性支气管收缩（EIB）的金标准。气道阻塞在挑战后 30 分钟内出现，肺活量测定和气道阻力的最大下降。有证据表明，体描法参数的变化对运动挑战更为敏感，并先于肺活量测定的变化。
比较运动挑战后体描法和肺活量测定参数的变化，并验证 sReff 在 EIB 中的截断值。
在 82 名疑似 EIB 的受试者中，在支气管阻塞的不同阶段，在运动挑战后 5、10、15 和 30 分钟，共测量了 473 次肺功能测试。
体描法参数 sReff 的最大变化明显早于肺活量测定参数 FEV 的最大变化（sReff：12.2 分钟±8.8，FEV：15.2 分钟±9.3，p<0.005）。sReff 和 FEV 参数呈强负相关（r=-0.63，p<0.0001），呈非线性，多项式关系。此外，sReff 和 Reff 具有很强的线性相关性（r=0.86，p<0.001），而 Reff 和 Rtot 具有完美的线性相关性（r=0.99，p<0.001）。基于基线值和分位数回归，sReff 增加 0.25 kPa·s 被定义为显著。使用该截断值，FEV 和 sReff 几乎同样能够检测到 EIB。
sReff 的变化比 FEV 的变化更敏感，更好地表明了肺损伤，而 FEV 的变化低估了过度充气的程度。
