Clinical implications of having reduced mid forced expiratory flow rates (FEF25-75), independently of FEV1, in adult patients with asthma

Craig M. Riley, Sally E. Wenzel, Mario Castro, Serpil C. Erzurum, Kian Fan Chung, Anne M. Fitzpatrick, Benjamin Gaston, Elliot Israel, Wendy C. Moore, Eugene R. Bleecker, William Calhoun, Nizar N. Jarjour, William W. Busse, Stephen P. Peters, W. Gerald Teague, Ronald Sorkness, Fernando Holguin

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Introduction: FEF25-75 is one of the standard results provided in spirometry reports; however, in adult asthmatics there is limited information on how this physiological measure relates to clinical or biological outcomes independently of the FEV1 or the FEV1/FVC ratio. Purpose: To determine the association between Hankinson's percent-predicted FEF25-75 (FEF25-75%) levels with changes in healthcare utilization, respiratory symptom frequency, and biomarkers of distal airway inflammation. Methods: In participants enrolled in the Severe Asthma Research Program 1-2, we compared outcomes across FEF25-75% quartiles. Multivariable analyses were done to avoid confounding by demographic characteristics, FEV1, and the FEV1/FVC ratio. In a sensitivity analysis, we also compared outcomes across participants with FEF25-75% below the lower limit of normal (LLN) and FEV1/FVC above LLN. Results: Subjects in the lowest FEF25-75% quartile had greater rates of healthcare utilization and higher exhaled nitric oxide and sputum eosinophils. In multivariable analysis, being in the lowest FEF25-75% quartile remained significantly associated with nocturnal symptoms (OR 3.0 [95%CI 1.3-6.9]), persistent symptoms (OR 3.3 [95%CI 1-11], ICU admission for asthma (3.7 [1.3-10.8]) and blood eosinophil % (0.18 [0.07, 0.29]). In the sensitivity analysis, those with FEF25-75% 1 and FEV1/FVC, a reduced FEF25-75% is independently associated with previous ICU admission, persistent symptoms, nocturnal symptoms, blood eosinophilia and bronchial hyperreactivity. This suggests that in some asthmatics, a reduced FEF25-75% is an independent biomarker for more severe asthma.

Original languageEnglish (US)
Article numbere0145476
JournalPLoS One
Volume10
Issue number12
DOIs
StatePublished - Dec 1 2015

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Forced Expiratory Flow Rates
Intensive care units
asthma
Biomarkers
signs and symptoms (animals and humans)
Sensitivity analysis
Blood
Asthma
Flow rate
Eosinophils
Bronchial Hyperreactivity
Delivery of Health Care
eosinophils
Nitric Oxide
Spirometry
health services
Association reactions
Eosinophilia
biomarkers
Sputum

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Riley, C. M., Wenzel, S. E., Castro, M., Erzurum, S. C., Chung, K. F., Fitzpatrick, A. M., ... Holguin, F. (2015). Clinical implications of having reduced mid forced expiratory flow rates (FEF25-75), independently of FEV1, in adult patients with asthma. PLoS One, 10(12), [e0145476]. https://doi.org/10.1371/journal.pone.0145476

Clinical implications of having reduced mid forced expiratory flow rates (FEF25-75), independently of FEV1, in adult patients with asthma. / Riley, Craig M.; Wenzel, Sally E.; Castro, Mario; Erzurum, Serpil C.; Chung, Kian Fan; Fitzpatrick, Anne M.; Gaston, Benjamin; Israel, Elliot; Moore, Wendy C.; Bleecker, Eugene R.; Calhoun, William; Jarjour, Nizar N.; Busse, William W.; Peters, Stephen P.; Teague, W. Gerald; Sorkness, Ronald; Holguin, Fernando.

In: PLoS One, Vol. 10, No. 12, e0145476, 01.12.2015.

Research output: Contribution to journalArticle

Riley, CM, Wenzel, SE, Castro, M, Erzurum, SC, Chung, KF, Fitzpatrick, AM, Gaston, B, Israel, E, Moore, WC, Bleecker, ER, Calhoun, W, Jarjour, NN, Busse, WW, Peters, SP, Teague, WG, Sorkness, R & Holguin, F 2015, 'Clinical implications of having reduced mid forced expiratory flow rates (FEF25-75), independently of FEV1, in adult patients with asthma', PLoS One, vol. 10, no. 12, e0145476. https://doi.org/10.1371/journal.pone.0145476
Riley, Craig M. ; Wenzel, Sally E. ; Castro, Mario ; Erzurum, Serpil C. ; Chung, Kian Fan ; Fitzpatrick, Anne M. ; Gaston, Benjamin ; Israel, Elliot ; Moore, Wendy C. ; Bleecker, Eugene R. ; Calhoun, William ; Jarjour, Nizar N. ; Busse, William W. ; Peters, Stephen P. ; Teague, W. Gerald ; Sorkness, Ronald ; Holguin, Fernando. / Clinical implications of having reduced mid forced expiratory flow rates (FEF25-75), independently of FEV1, in adult patients with asthma. In: PLoS One. 2015 ; Vol. 10, No. 12.
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AU - Riley, Craig M.

AU - Wenzel, Sally E.

AU - Castro, Mario

AU - Erzurum, Serpil C.

AU - Chung, Kian Fan

AU - Fitzpatrick, Anne M.

AU - Gaston, Benjamin

AU - Israel, Elliot

AU - Moore, Wendy C.

AU - Bleecker, Eugene R.

AU - Calhoun, William

AU - Jarjour, Nizar N.

AU - Busse, William W.

AU - Peters, Stephen P.

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AU - Sorkness, Ronald

AU - Holguin, Fernando

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N2 - Introduction: FEF25-75 is one of the standard results provided in spirometry reports; however, in adult asthmatics there is limited information on how this physiological measure relates to clinical or biological outcomes independently of the FEV1 or the FEV1/FVC ratio. Purpose: To determine the association between Hankinson's percent-predicted FEF25-75 (FEF25-75%) levels with changes in healthcare utilization, respiratory symptom frequency, and biomarkers of distal airway inflammation. Methods: In participants enrolled in the Severe Asthma Research Program 1-2, we compared outcomes across FEF25-75% quartiles. Multivariable analyses were done to avoid confounding by demographic characteristics, FEV1, and the FEV1/FVC ratio. In a sensitivity analysis, we also compared outcomes across participants with FEF25-75% below the lower limit of normal (LLN) and FEV1/FVC above LLN. Results: Subjects in the lowest FEF25-75% quartile had greater rates of healthcare utilization and higher exhaled nitric oxide and sputum eosinophils. In multivariable analysis, being in the lowest FEF25-75% quartile remained significantly associated with nocturnal symptoms (OR 3.0 [95%CI 1.3-6.9]), persistent symptoms (OR 3.3 [95%CI 1-11], ICU admission for asthma (3.7 [1.3-10.8]) and blood eosinophil % (0.18 [0.07, 0.29]). In the sensitivity analysis, those with FEF25-75% 1 and FEV1/FVC, a reduced FEF25-75% is independently associated with previous ICU admission, persistent symptoms, nocturnal symptoms, blood eosinophilia and bronchial hyperreactivity. This suggests that in some asthmatics, a reduced FEF25-75% is an independent biomarker for more severe asthma.

AB - Introduction: FEF25-75 is one of the standard results provided in spirometry reports; however, in adult asthmatics there is limited information on how this physiological measure relates to clinical or biological outcomes independently of the FEV1 or the FEV1/FVC ratio. Purpose: To determine the association between Hankinson's percent-predicted FEF25-75 (FEF25-75%) levels with changes in healthcare utilization, respiratory symptom frequency, and biomarkers of distal airway inflammation. Methods: In participants enrolled in the Severe Asthma Research Program 1-2, we compared outcomes across FEF25-75% quartiles. Multivariable analyses were done to avoid confounding by demographic characteristics, FEV1, and the FEV1/FVC ratio. In a sensitivity analysis, we also compared outcomes across participants with FEF25-75% below the lower limit of normal (LLN) and FEV1/FVC above LLN. Results: Subjects in the lowest FEF25-75% quartile had greater rates of healthcare utilization and higher exhaled nitric oxide and sputum eosinophils. In multivariable analysis, being in the lowest FEF25-75% quartile remained significantly associated with nocturnal symptoms (OR 3.0 [95%CI 1.3-6.9]), persistent symptoms (OR 3.3 [95%CI 1-11], ICU admission for asthma (3.7 [1.3-10.8]) and blood eosinophil % (0.18 [0.07, 0.29]). In the sensitivity analysis, those with FEF25-75% 1 and FEV1/FVC, a reduced FEF25-75% is independently associated with previous ICU admission, persistent symptoms, nocturnal symptoms, blood eosinophilia and bronchial hyperreactivity. This suggests that in some asthmatics, a reduced FEF25-75% is an independent biomarker for more severe asthma.

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