The Role of Spirometry and MMEF in Pediatric Asthma Monitoring and Prediction of Exacerbations

Background: Asthma is the most common chronic disease during childhood. Spirometry is recommended as a reliable lung function test. Several studies have demonstrated the lack of use of spirometry for both diagnostic confirmation and monitoring. Using subjective symptom control tests alone may underestimate the risk for future asthma attacks. Methods/Objectives: We conducted a retrospective, observational study in a single pediatric centre in Romania. The main objectives of the study were to analyse the quality of spirometry in children and to emphasise the importance of performing accurate spirometry for asthma monitoring. The secondary objective was to evaluate if forced expiratory volume in the first second (FEV1) and mid-maximum expiratory flow (MMEF) values are predictive markers for future exacerbations in children with asthma. Results: The study group included 416 patients between 5 and 18 years who performed at least one spirometry. The success rate for spirometry in our study was 66.3%. In a subsequent study group of 88 patients we monitored spirometry initially and after 12 months. We found a statistically significant difference between FEV1 and MMEF in the controlled, partially controlled and uncontrolled groups (p = 0.0102 and p = 0.0001). Our study showed no association between FEV1 and risk for exacerbations (Rs = -0.156, p = 0.146) and an acceptably negative (Rs = -0.30) and statistically significant (p = 0.040) correlation between initial MMEF values and the number of exacerbations. Conclusions: Low initial MMEF values correlate with the number of exacerbations in a 12-month follow-up period. This suggests that evaluating MMEF alongside FEV1 in children with asthma could contribute to better identification of the risk of exacerbation.