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Variability in forced expiratory volume in 1 s in children with symptomatically well-controlled asthma
Nicole Filipow1, Stephen Turner2,3, Helen L Petsky4
1Great Ormond Street Institute of Child Health, University College London, London, UK.
Thorax
|September 27, 2024
Summary
Spirometry variability in children with asthma is wide. Clinical decisions for asthma management should prioritize symptoms over spirometry changes.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Clinical Trials
Background:
- Spirometry is crucial for monitoring childhood asthma.
- Understanding the variability of spirometry measurements over time is essential for accurate asthma management.
- Current understanding of FEV1 variability in well-controlled pediatric asthma is limited.
Purpose of the Study:
- To determine the variability of forced expiratory volume in 1 second (FEV1) in children with symptomatically well-controlled asthma.
- To compare three methods for expressing FEV1 change over 3-month intervals: FEV1% predicted (FEV1%), FEV1 z-score (FEV1z), and conditional z-score for change (Zc).
Main Methods:
- Analysis of longitudinal data from five pediatric asthma studies.
- Inclusion of FEV1 measurements taken at 3-month intervals over 6 or 12 months.
- Calculation of limits of agreement for FEV1%, FEV1z, and Zc to express variability.
Main Results:
- A total of 881 children provided 3338 FEV1 measurements during controlled asthma periods.
- Wide limits of agreement were observed for FEV1% (-20 to +21) and FEV1z (-1.7 to +1.7).
- The conditional z-score (Zc) showed narrower limits of agreement (-2.6 to +2.1) and was less affected by regression to the mean or younger age.
Conclusions:
- Paired FEV1 measurements in symptomatically well-controlled children exhibit significant variability.
- Asthma treatment decisions in children should primarily rely on symptom assessment.
- Spirometry changes alone may not be a reliable indicator for adjusting asthma therapy in well-controlled cases.
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