STATE ORGANIZATION "NATIONAL INSTITUTE OF PHTHISIOLOGY AND PULMONOLOGY NAMED AFTER F.G. YANOVSKY NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE", KYIV, UKRAINE.
POLTAVA STATE MEDICAL UNIVERSITY, POLTAVA, UKRAINE.
Wiad Lek. 2024;77(7):1456-1463. doi: 10.36740/WLek202407121.
Aim: To develop the criteria of small airways response to bronchodilators (by spirometry indices maximal expiratory flow (MEF50 and MEF25) as the markers of uncontrolled asthma course.
Materials and Methods: The study involved 92 participants (64 boys and 28 girls) aged 6 to 17 years (60 were less than 12 years old) with diagnosed asthma. Asthma control was assessed with the use of Asthma Control Test and Asthma Control Questionnaire. Spirometry and bronchodilator responsiveness testing were performed for all participants.
Results: Mostly, the studied children had a normal level of forced expiratory volume in the first second (FEV1), even at unsatisfactory symptoms control. The indicators of the medium and small airways patency were significantly worse in uncontrolled asthma children even in normal FEV1. Among children, the lack of asthma control can be caused by small airways obstruction in up to 80% cases. Among children who need the high dose inhaled corticosteroids treatment 93.3% have uncontrolled asthma with small airways obstruction. We found out that MEF50 and MEF25 could be the signs of the reversibility of bronchial obstruction and uncontrolled asthma with high sensitivity and specificity.
Conclusions: Indices MEF50 and MEF25 allow detecting the small airways obstruction and their reversibility as a mark of uncontrolled asthma (MEF25 has a higher diagnostic value). In case of MEF50 and/or MEF25 increasing for 22% or 25% accordingly in bronchodilator test in children, the asthma should be considered uncontrolled.
目的：旨在通过最大呼气流量（MEF50 和 MEF25 等呼吸量指标）制定小气道对支气管扩张剂的反应标准，作为未控制哮喘病程的标志物。
材料和方法：本研究纳入了 92 名年龄在 6 至 17 岁（其中 60 名患者年龄小于 12 岁）的确诊哮喘患者（64 名男孩和 28 名女孩）。采用哮喘控制测试（ACT）和哮喘控制问卷（ACQ）评估哮喘控制情况。所有参与者均进行了肺量测定和支气管扩张剂反应性测试。
结果：在研究中，大多数患有哮喘的儿童第一秒用力呼气量（FEV1）处于正常水平，即使症状控制不理想。在未控制哮喘的儿童中，即使 FEV1 正常，中、小气道通畅的指标也明显更差。在儿童中，高达 80%的哮喘控制不佳是由小气道阻塞引起的。在需要高剂量吸入皮质类固醇治疗的儿童中，93.3%存在小气道阻塞的未控制哮喘。我们发现 MEF50 和 MEF25 可作为支气管阻塞可逆性和未控制哮喘的标志，具有较高的敏感性和特异性。
结论：MEF50 和 MEF25 可用于检测小气道阻塞及其可逆性，作为未控制哮喘的标志物（MEF25 具有更高的诊断价值）。在支气管扩张剂测试中，MEF50 和/或 MEF25 增加 22%或 25%，则应考虑哮喘未控制。
