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FEF25-75: A marker for small airways and asthma control
Ann Allergy Asthma Immunol xxx (2013) 1
Contents lists available at SciVerse ScienceDirect
Correspondence
FEF25-75: A marker for small airways and asthma control To the Editor: The interesting paper of Lipworth1 reports that the forced mid-expiratory flow between 25% and 75% of forced vital capacity (FEF25-75) is considered to be more reflective of small airways than the forced expiratory volume in 1 second (FEV1).1 However, we would like to highlight some noteworthy issues about the clinical relevance of FEF25-75 in patients with respiratory allergy. First, an FEF25-75 value less than 65% of predicted has been defined as impaired.2 Consequently, finding impaired FEF25-75 value may be relevant in allergic patients, because it may suggest: 1. Early bronchial involvement in patients with recent onset of allergic rhinitis3 2. Severe bronchial hyperreactivity in patients with asthma or rhinitis4 3. Positive response to bronchodilation test in patients with asthma5 4. Bronchial inflammation as assessed by FeNO measurement6 5. Significant relationship with adiposity7 6. Significant relationship with the perception of breathlessness in children with asthma8 7. Significant association with symptom duration and sensitization to perennial allergens in patients with rhinitis9 Therefore, FEF25-75 should not be considered only a surrogate marker for assessing small airways, but it has to be carefully considered when impaired, because it should be interpreted as a sign of bronchial impairment, mainly in patients with normal FEV1 values. Moreover, the introduction of the article is based on the concept that identifying patients with the small airways asthma phenotype may be useful for designing appropriate strategy to treat peripheral airways dysfunction to achieve optimal asthma control.1 In this regard, we are still evaluating a large cohort of patients with asthma, aiming at investigating clinical and functional factors that could affect asthma control. Preliminary findings show that FEF25-75 values are significantly associated (P ¼ .003) with asthma control. In particular, patients with controlled asthma have significantly higher FEF25-75 values than patients with slightly controlled asthma (P ¼ .012) and asthma that is not controlled (P ¼ .004). Thus, we would like to underline the clinical relevance of adequately considering the FEF25-75 parameter in the management of patients with asthma, mainly in subjects with normal FEV1 values and uncontrolled asthma.
In conclusion, impaired FEF25-75 values (such as <65% of predicted) should be adequately considered in patients with asthma with poor control to reevaluate the therapeutic strategy. Giorgio Ciprandi, MD* Ignazio Cirillo, MDy Fabiola Pasotti, MD* Fabio Luigi Massimo Ricciardolo, MDz *Department of Medicine IRCCS-Azienda Ospedaliera Universitaria San Martino Genoa, Italy y Department of Medicine Navy Medical Service La Spezia, Italy z Division of Respiratory Disease Department of Clinical and Biological Sciences University of Torino Turin, Italy [email protected]
References [1] Lipworth B. Targeting the small airways asthma phenotype: if we can reach it, should we treat it? Ann Allergy Asthma Immunol. 2013;110:233e239. [2] Ciprandi G, Capasso M, Tosca MA, et al. FEF25-75 cut-off value in allergic children with asthma. Allergy Asthma Proc. 2012;33:5e8. [3] Ciprandi G, Cirillo I, Klersy C. Lower airways are affected also in asymptomatic patients with recent onset of allergic rhinitis. Laryngoscope. 2010;120: 1288e1291. [4] Cirillo I, Klersy C, Marseglia GL, et al. Role of FEF25-75 as predictor of bronchial hyperreactivity in allergic patients. Ann Allergy Asthma Immunol. 2006;96: 692e700. [5] Simon MR, Chinchilli VM, Phillips BR, et al. Forced expiratory flow between 25% and 75% of vital capacity and FEV1/forced vital capacity ratio in relation to clinical and physiological parameters in asthmatic children with normal FEV1 values. J Allergy Clin Immunol. 2010;126:527e534. [6] Ciprandi G, Tosca MA, Cirillo I, et al. Impaired FEF25-75 may predict high exhaled nitric oxide values in children with allergic rhinitis and/or asthma. J Biol Regul. 2012;26:27e34. [7] Ciprandi G, Pistorio A, Tosca M, Ferraro MR, Cirillo I. Body mass index, respiratory function and bronchial hyperreactivity in allergic rhinitis and asthma. Respir Med. 2009;103:289e295. [8] Tosca MA, Silvestri M, Olcese R, Pistorio A, Rossi GA, Ciprandi G. Breathlessness perception assessed by visual analogue scale and lung function in children with asthma: a real-life study. Pediatr Allergy Immunol. 2012;23: 537e542. [9] Ciprandi G, Cirillo I, Pistorio A. Impact of allergic rhinitis on asthma: effects on spirometric parameters. Allergy. 2008;63:255e260.
Disclosures: Authors have nothing to disclose. 1081-1206/13/$36.00 - see front matter Ó 2013 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.anai.2013.06.012
Contents lists available at SciVerse ScienceDirect
Correspondence
FEF25-75: A marker for small airways and asthma control To the Editor: The interesting paper of Lipworth1 reports that the forced mid-expiratory flow between 25% and 75% of forced vital capacity (FEF25-75) is considered to be more reflective of small airways than the forced expiratory volume in 1 second (FEV1).1 However, we would like to highlight some noteworthy issues about the clinical relevance of FEF25-75 in patients with respiratory allergy. First, an FEF25-75 value less than 65% of predicted has been defined as impaired.2 Consequently, finding impaired FEF25-75 value may be relevant in allergic patients, because it may suggest: 1. Early bronchial involvement in patients with recent onset of allergic rhinitis3 2. Severe bronchial hyperreactivity in patients with asthma or rhinitis4 3. Positive response to bronchodilation test in patients with asthma5 4. Bronchial inflammation as assessed by FeNO measurement6 5. Significant relationship with adiposity7 6. Significant relationship with the perception of breathlessness in children with asthma8 7. Significant association with symptom duration and sensitization to perennial allergens in patients with rhinitis9 Therefore, FEF25-75 should not be considered only a surrogate marker for assessing small airways, but it has to be carefully considered when impaired, because it should be interpreted as a sign of bronchial impairment, mainly in patients with normal FEV1 values. Moreover, the introduction of the article is based on the concept that identifying patients with the small airways asthma phenotype may be useful for designing appropriate strategy to treat peripheral airways dysfunction to achieve optimal asthma control.1 In this regard, we are still evaluating a large cohort of patients with asthma, aiming at investigating clinical and functional factors that could affect asthma control. Preliminary findings show that FEF25-75 values are significantly associated (P ¼ .003) with asthma control. In particular, patients with controlled asthma have significantly higher FEF25-75 values than patients with slightly controlled asthma (P ¼ .012) and asthma that is not controlled (P ¼ .004). Thus, we would like to underline the clinical relevance of adequately considering the FEF25-75 parameter in the management of patients with asthma, mainly in subjects with normal FEV1 values and uncontrolled asthma.
In conclusion, impaired FEF25-75 values (such as <65% of predicted) should be adequately considered in patients with asthma with poor control to reevaluate the therapeutic strategy. Giorgio Ciprandi, MD* Ignazio Cirillo, MDy Fabiola Pasotti, MD* Fabio Luigi Massimo Ricciardolo, MDz *Department of Medicine IRCCS-Azienda Ospedaliera Universitaria San Martino Genoa, Italy y Department of Medicine Navy Medical Service La Spezia, Italy z Division of Respiratory Disease Department of Clinical and Biological Sciences University of Torino Turin, Italy [email protected]
References [1] Lipworth B. Targeting the small airways asthma phenotype: if we can reach it, should we treat it? Ann Allergy Asthma Immunol. 2013;110:233e239. [2] Ciprandi G, Capasso M, Tosca MA, et al. FEF25-75 cut-off value in allergic children with asthma. Allergy Asthma Proc. 2012;33:5e8. [3] Ciprandi G, Cirillo I, Klersy C. Lower airways are affected also in asymptomatic patients with recent onset of allergic rhinitis. Laryngoscope. 2010;120: 1288e1291. [4] Cirillo I, Klersy C, Marseglia GL, et al. Role of FEF25-75 as predictor of bronchial hyperreactivity in allergic patients. Ann Allergy Asthma Immunol. 2006;96: 692e700. [5] Simon MR, Chinchilli VM, Phillips BR, et al. Forced expiratory flow between 25% and 75% of vital capacity and FEV1/forced vital capacity ratio in relation to clinical and physiological parameters in asthmatic children with normal FEV1 values. J Allergy Clin Immunol. 2010;126:527e534. [6] Ciprandi G, Tosca MA, Cirillo I, et al. Impaired FEF25-75 may predict high exhaled nitric oxide values in children with allergic rhinitis and/or asthma. J Biol Regul. 2012;26:27e34. [7] Ciprandi G, Pistorio A, Tosca M, Ferraro MR, Cirillo I. Body mass index, respiratory function and bronchial hyperreactivity in allergic rhinitis and asthma. Respir Med. 2009;103:289e295. [8] Tosca MA, Silvestri M, Olcese R, Pistorio A, Rossi GA, Ciprandi G. Breathlessness perception assessed by visual analogue scale and lung function in children with asthma: a real-life study. Pediatr Allergy Immunol. 2012;23: 537e542. [9] Ciprandi G, Cirillo I, Pistorio A. Impact of allergic rhinitis on asthma: effects on spirometric parameters. Allergy. 2008;63:255e260.
Disclosures: Authors have nothing to disclose. 1081-1206/13/$36.00 - see front matter Ó 2013 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.anai.2013.06.012