Wei Sulan, Zhao Zhen, Zhu Guiping, Lu Chong, Jiao Daozhen, Ye Ling, Song Yuanlin, Jin Meiling, Wang Jian, Cai Hui
Drs. Wei, Zhu, Ye, Song, Jin, Wang, Cai, Mr. Zhao, Lu, and Jiao are affiliated with Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
Drs. Ye and Jin are affiliated with Department of Allergy, Zhongshan Hospital, Fudan University, Shanghai, China.
Respir Care. 2025 Jul;70(7):847-854. doi: 10.1089/respcare.12039. Epub 2025 Feb 20.
Bronchial provocation test (BPT) plays a crucial role in diagnosing airway hyper-responsiveness (AHR) among patients with asthma-like symptoms. Given that BPT may induce severe bronchospasm, baseline spirometric parameters are expected to help predict a positive outcome, guiding the decision of referring a patient to BPT. Baseline spirometry and BPT conducted on suspected asthmatics between July 2011 and 2013 at Department of Pulmonary Medicine, Zhongshan Hospital, were retrospectively collected. Baseline characteristics from positive and negative BPT groups were compared. The predictive accuracy of single parameter for AHR was evaluated by plotting receiver operating characteristic curve, and a composite model was developed to improve the accuracy by the logistic regression. The relationships of FEV/FVC, FEV %predicted, and forced expiratory flow at 50% of FVC exhaled (FEF %predicted) with the provocation dose causing a 20% fall in FEV (PD-FEV) were examined. The positive BPT group exhibited reduced FEV %predicted, FEV/FVC, and small airway function parameters compared with the negative group. Among these parameters, FEF %predicted, forced expiratory flow at 75% of FVC exhaled (FEF %predicted), and forced expiratory flow between 25% and 75% (FEF %predicted) demonstrated significant accuracy. Notably, females and younger subjects were more prone to a positive outcome. A predictive model that combined FEV %predicted (cutoff 98.65%, area under the curve 0.714, sensitivity 39.10%, specificity 88.10%), FEV/FVC (cutoff 79.22%, area under the curve 0.690, sensitivity 32.80%, specificity 90.50%), and FEF %predicted (cutoff 74.45%, area under the curve 0.761, sensitivity 50.50%, specificity 84.60%) with age and gender was found to enhance the accuracy for a positive BPT (area under the curve 0.786, 95% CI 0.758-0.814, sensitivity 52.27%, specificity 86.14%). Moreover, FEV/FVC, FEF %predicted, and FEF %predicted showed differences among groups with varying AHR levels. The significant correlations between these 3 parameters and PD-FEV were exclusively demonstrated in the severe AHR group. This study revealed that FEV %predicted, FEV/FVC, and FEF %predicted along with age and gender were predictors of AHR in subjects with suspected asthma. Their combination improved the predictive accuracy over using FEF %predicted alone, thus offering a complement for clinical decision-making regarding referrals to BPT.
支气管激发试验（BPT）在诊断有哮喘样症状患者的气道高反应性（AHR）中起着关键作用。鉴于BPT可能诱发严重支气管痉挛，预计基线肺功能参数有助于预测阳性结果，从而指导决定是否将患者转诊进行BPT。回顾性收集了2011年7月至2013年期间在中山医院呼吸内科对疑似哮喘患者进行的基线肺功能检查和BPT数据。比较了BPT阳性和阴性组的基线特征。通过绘制受试者工作特征曲线评估单个参数对AHR的预测准确性，并通过逻辑回归建立复合模型以提高准确性。研究了第1秒用力呼气容积/用力肺活量（FEV/FVC）、第1秒用力呼气容积占预计值百分比（FEV%predicted）和呼出50%用力肺活量时的用力呼气流量占预计值百分比（FEF%predicted）与导致第1秒用力呼气容积下降20%的激发剂量（PD-FEV）之间的关系。与阴性组相比，BPT阳性组的FEV%predicted、FEV/FVC和小气道功能参数降低。在这些参数中，FEF%predicted、呼出75%用力肺活量时的用力呼气流量占预计值百分比（FEF%predicted）和25%至75%用力肺活量之间的用力呼气流量占预计值百分比（FEF%predicted）显示出显著的准确性。值得注意的是，女性和年轻受试者更易出现阳性结果。发现一个结合了FEV%predicted（截断值98.65%，曲线下面积0.714，灵敏度39.10%，特异性88.10%）、FEV/FVC（截断值79.22%，曲线下面积0.690，灵敏度32.80%，特异性90.50%）和FEF%predicted（截断值74.45%，曲线下面积0.761，灵敏度50.50%，特异性84.60%）以及年龄和性别的预测模型可提高BPT阳性的准确性（曲线下面积0.786，95%置信区间0.758 - 0.814，灵敏度52.27%，特异性86.14%）。此外，FEV/FVC、FEF%predicted和FEF%predicted在不同AHR水平的组间存在差异。这3个参数与PD-FEV之间的显著相关性仅在重度AHR组中得到证实。本研究表明，FEV%predicted、FEV/FVC和FEF%predicted以及年龄和性别是疑似哮喘患者AHR的预测指标。它们的组合比单独使用FEF%predicted提高了预测准确性，从而为关于转诊进行BPT的临床决策提供了补充。
