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Prevalence, stability, and clinical significance of an isolated low FEV1 spirometry pattern in children
MacKenzie L Wyatt1,2, Andrew G Sokolow1, Rebekah F Brown1
1Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Insights
The isolated low forced expiratory volume in 1 second (FEV1) pattern is uncommon in children but may indicate increased risk for lung disease, particularly in cystic fibrosis (CF) patients. This pattern often resolves over time and is not due to poor spirometry technique.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Spirometry Interpretation
Background:
- An isolated low forced expiratory volume in 1 second (FEV1) pattern, characterized by FEV1 below the lower limit of normal with preserved forced vital capacity (FVC) and FEV1/FVC ratio, is linked to airway obstruction risk in adults.
- Understanding this pattern's prevalence, stability, and clinical significance in children is crucial for early detection and management of pediatric lung diseases.
Purpose of the Study:
- To determine the prevalence, stability, and clinical relevance of an isolated low FEV1 pattern in the pediatric population.
- To investigate the association between this spirometry pattern and clinical markers in children with cystic fibrosis (CF).
Main Methods:
- Retrospective analysis of 29,979 spirometries from children aged 6-21 years.
- Categorization of spirometry patterns based on established guidelines.
- Evaluation of spirometry technique quality and association with clinical data in subgroups, including children with CF.
Main Results:
- The isolated low FEV1 pattern was identified in 2% of pediatric spirometries (n=645).
- In children with a follow-up test, 47% (n=123) normalized their pattern.
- Cystic fibrosis diagnosis significantly increased the odds of an isolated low FEV1 pattern (OR=8.37).
- In CF patients, an isolated low FEV1 pattern correlated with higher oral antibiotic use (OR=3.50).
Conclusions:
- The isolated low FEV1 pattern, while uncommon, can persist but often resolves to a normal pattern in children.
- This pattern is not attributable to poor spirometry technique.
- The isolated low FEV1 pattern may hold clinical relevance, particularly in pediatric chronic lung diseases like CF.
Objectives:
In adults, an isolated low FEV1 pattern (an FEV1 below the lower limit of normal with a preserved FVC and FEV1/FVC) has been associated with the risk of developing airway obstruction. Our objective was to examine the prevalence, stability, and clinical significance of an isolated low FEV1 pattern in the pediatric population.
Methods:
We conducted a retrospective study of spirometries from children ages 6-21 years and categorized tests into spirometry patterns according to published guidelines and recent literature. In a subgroup of tests with an isolated low FEV1 pattern, we evaluated spirometry technique. We also examined the association of having a test with an isolated low FEV1 pattern with clinical markers of disease severity in a subgroup of children with cystic fibrosis (CF).
Results:
The isolated low FEV1 pattern was uncommon across the 29,979 tests included (n = 645 [2%]). In the 263 children with an isolated low FEV1 pattern who had a follow-up test performed, the most frequent spirometry pattern at last test was normal (n = 123 [47%]). A primary diagnosis of CF was associated with increased odds of having at least one test with an isolated low FEV1 pattern (OR = 8.37, 95% CI = 4.70-15.96, p < .001). The spirometry quality in a subgroup of tests with an isolated low FEV1 pattern (n = 50) was satisfactory. In the subgroup of children with CF (n = 102), those who had a test with an isolated low FEV1 pattern had higher odds of using oral antibiotics in the last 12 months than those who had a normal pattern (OR = 3.50, 95% CI = 1.15-10.63, p = .03).
Conclusions:
The isolated low FEV1 pattern can occur repeatedly over time, usually transitions to a normal pattern, is not due to a poor spirometry technique, and could be clinically relevant in children with chronic lung diseases.
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