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Spirometric changes in bronchodilation tests as predictors of asthma diagnosis and treatment response in patients with FEV1 ≥ 80% predicted
  • +10
  • Huijuan Hao,
  • Wuping Bao,
  • Yishu Xue,
  • Yan Zhou,
  • Zhixuan Huang,
  • Dongning Yin,
  • Yingying Zhang,
  • Pengyu Zhang,
  • Chengjian Lv,
  • Lei Han,
  • xin Zhou,
  • Junfeng Yin,
  • Min Zhang
Huijuan Hao
Shanghai Jiaotong University First People's Hospital
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Wuping Bao
Shanghai Jiaotong University First People's Hospital
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Yishu Xue
Shanghai Jiaotong University First People's Hospital
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Yan Zhou
Shanghai Jiaotong University First People's Hospital
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Zhixuan Huang
Tongji University
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Dongning Yin
Shanghai Jiaotong University First People's Hospital
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Yingying Zhang
Shanghai Jiaotong University First People's Hospital
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Pengyu Zhang
Shanghai First People's Hospital
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Chengjian Lv
Shanghai Jiaotong University First People's Hospital
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Lei Han
Shanghai Jiaotong University First People's Hospital
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xin Zhou
Shanghai Jiaotong University First People's Hospital
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Junfeng Yin
Tongji University
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Min Zhang
Shanghai Jiao Tong University
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Abstract

Background: Many patients with mild asthma are undiagnosed and untreated for low diagnostic sensitivity of the bronchodilation test (BDT). Objective: Investigating whether airway reversibility in BDT alone or together with fractional exhaled nitric oxide (FENO) can predict the response to anti-asthma therapy (RAT) in suspected asthma patients. Methods: This study included patients with chronic recurrent asthma symptoms, normal forced expiratory volume in 1 second (FEV1), and negative BDT. Inhaled corticosteroid (ICS) and long-acting β agonist (LABA) were given for 4 weeks. Positive RAT (PRAT) was defined as improved symptoms and increase of FEV1 > 200 mL after ICS/LABA. Lung tissues from 19 patients with lung nodules, grouped by predicted RAT, were also analyzed. Results: Of 102 patients, the PRAT group had higher FENO and greater absolute (∆) and (∆%) percent improvements of forced vital capacity, FEV1, and forced expiratory flows (FEFs) in BDT than the negative RAT group. The AUCs of FENO, ∆FEV1%, ∆FEF25-75%, and ∆FEF75% for PRAT were 0.703, 0.824, 0.736, and 0.710, with the optimal cut-off values of 33 ppb, 3.50%, 15.26%, and 26.04%. A joint model of FENO and ∆FEV1% increased the AUC to 0.880. IL-4, IL-5, IL-13, and NFκB were higher in lung tissues of patients with predicted PRAT than with predicted NRAT. Conclusion: ∆FEV1% > 3.50% in BDT together with FENO > 33 ppb predicted PRAT and an asthma diagnosis in patients with normal FEV1 and negative BDT. Evidence of pathological changes in the early stage of asthma increased the credibility of the predictive model.

Peer review status:Published

Mar 2021Published in The Journal of Allergy and Clinical Immunology: In Practice. 10.1016/j.jaip.2021.03.015