Relation of changes in PEF and FEV1 in exercise challenge in children

IF 1.3 4区医学 Q4 PHYSIOLOGY

Clinical Physiology and Functional Imaging Pub Date : 2023-11-07 DOI:10.1111/cpf.12864

Leon Csonka, Antti Tikkakoski, Anna P. Tikkakoski, Jussi Karjalainen, Lauri Lehtimäki

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Abstract

Decrease in forced expiratory volume in one second (FEV₁) of 10% or 15% in exercise challenge test is considered diagnostic for asthma, but a decrease of 15% in peak expiratory flow (PEF) is recommended as an alternative. Our aim was to assess the accuracy of different PEF cut-off points in comparison to FEV₁.

We retrospectively studied 326 free running exercise challenge tests with spirometry in children 6−16 years old. FEV₁ and PEF were measured before and 2, 5, 10 and 15 min after exercise. Receiver operating characteristics (ROC) analysis, sensitivity, specificity, positive and negative predictive values (PPV and NPV) and ϰ-coefficient were used to analyse how decrease in PEF predicts decrease of 10% or 15% in FEV₁.

In the ROC analysis, areas under the curve were 0.851 (p < 0.001) and 0.921 (p < 0.001) for PEF decrease to predict a 10% and 15% decrease in FEV₁, respectively. The agreement between changes in PEF and FEV₁ varied from slight to substantial (ϰ values of 0.199–0.680) depending on the cut-points. Lower cut-off for decrease in PEF had higher sensitivity and NPV, while higher cut-off values had better specificity and PPV. Decrease of 20% and 25% in PEF seemed to be the best cut-offs for detecting 10% and 15% decrease in FEV₁, respectively. Still, a fifth of the positive findings based on PEF were false.

Change in PEF is not a precise predictor of change in FEV₁ in exercise test. The currently recommended cut-point of 15% decrease in PEF seems to be too low and leads to high false positive rate.

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儿童运动挑战时PEF和FEV1变化的关系。

运动激发试验中1秒用力呼气量（FEV1）降低10%或15%被认为是哮喘的诊断，但建议将呼气峰流量（PEF）降低15%作为替代方案。我们的目的是与FEV1相比，评估不同PEF截止点的准确性。我们回顾性研究了326例6-16岁儿童的自由跑运动挑战性肺活量测试。在运动前和运动后2、5、10和15分钟测量FEV1和PEF。ROC分析、敏感性、特异性、阳性和阴性预测值（PPV和NPV）以及kappa系数用于分析PEF的降低如何预测FEV1的降低10%或15%。在ROC分析中，曲线下的面积分别为0.851（p1）。PEF和FEV1的变化之间的一致性从轻微到显著不等（kappa值为0.199-0.680），具体取决于切割点。PEF降低的下限具有更高的灵敏度和NPV，而较高的下限值具有更好的特异性和PPV。PEF降低20%和25%似乎是检测FEV1分别降低10%和15%的最佳截止值。尽管如此，五分之一基于PEF的阳性结果是错误的。PEF的变化并不能准确预测运动测试中FEV1的变化。目前建议的PEF降低15%的分界点似乎太低，导致高假阳性率。这篇文章受版权保护。保留所有权利。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Physiology and Functional Imaging 医学-生理学

CiteScore

3.40

自引率

5.60%

发文量

审稿时长

6-12 weeks

期刊介绍： Clinical Physiology and Functional Imaging publishes reports on clinical and experimental research pertinent to human physiology in health and disease. The scope of the Journal is very broad, covering all aspects of the regulatory system in the cardiovascular, renal and pulmonary systems with special emphasis on methodological aspects. The focus for the journal is, however, work that has potential clinical relevance. The Journal also features review articles on recent front-line research within these fields of interest. Covered by the major abstracting services including Current Contents and Science Citation Index, Clinical Physiology and Functional Imaging plays an important role in providing effective and productive communication among clinical physiologists world-wide.