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Asthma, FEF25-75, and Hospitalizations in Children.

Elizabeth R Gibb1, Shannon M Thyne2, Daniel N Kaplan1

  • 1Division of Pulmonary Medicine, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, California.

Pediatric Allergy, Immunology, and Pulmonology
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Summary

Reduced forced expiratory flow between 25%-75% (FEF25-75) in children with asthma may predict hospitalizations, even with normal forced expiratory volume in 1 second (FEV1). This finding suggests FEF25-75 is crucial for assessing pediatric asthma control.

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Area of Science:

  • Pediatric Pulmonology
  • Respiratory Medicine
  • Clinical Pediatrics

Background:

  • Asthma is a prevalent chronic respiratory condition in children, contributing to significant morbidity.
  • Current asthma management guidelines emphasize monitoring forced expiratory volume in 1 second (FEV1).
  • However, a normal FEV1 in children does not always correlate with well-controlled asthma symptoms or severity.

Purpose of the Study:

  • To investigate the association between reduced forced expiratory flow between 25%-75% of vital capacity (FEF25-75) and asthma-related hospitalizations in children.
  • To determine if FEF25-75 is a valuable indicator of asthma severity and control, particularly in children with a normal FEV1.

Main Methods:

  • Retrospective review of pulmonary function tests and medical records for 925 children (≤19 years) diagnosed with asthma.
  • Data collected from a community-based asthma clinic between 1999 and 2011.
  • Logistic regression models used to analyze the association between FEV1, FEF25-75, and asthma-related hospitalizations.

Main Results:

  • Asthma-related hospitalization was significantly associated with decreasing categories of FEF25-75, but not FEV1.
  • Among children with a normal FEV1 (≥80% predicted), those with FEF25-75 <60% predicted were more likely to have been hospitalized (OR 2.50, 95% CI 1.17-5.35).
  • Fifty-four percent of the cohort had uncontrolled asthma symptoms, and 13% were hospitalized in the previous year.

Conclusions:

  • Reduced FEF25-75 is associated with increased asthma-related hospitalizations in children, even when FEV1 is normal.
  • FEF25-75 may serve as a critical marker for assessing asthma severity and guiding management in pediatric patients.
  • These findings highlight the importance of incorporating FEF25-75 into routine asthma assessments for children.