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Acceptability, Reproducibility, and Sensitivity of Forced Expiratory Volumes and Peak Expiratory Flow During Bronchial Challenge Testing in Asthmatic Children^*

^* From the Division of Allergology (Drs. Malmberg, Pelkonen, Syvänen, Haahtela, Turpeinen, and Mrs. Koljonen), Helsinki University Central Hospital, Helsinki, Finland; and AstraZeneca R & D (Mr. Nikander), Lund, Sweden.

Correspondence to: L. Pekka Malmberg, MD, PhD, Division of Allergology, Helsinki University Central Hospital, PO Box 160, FIN-00029 Helsinki, Finland; e-mail: pekka.malmberg{at}hus.fi

Objectives: To compare the acceptability, reproducibility, and sensitivity of spirometric outcome measures of airway caliber during challenge testing in children.

Design: FEV₁, forced expiratory volume in 0.75 s, forced expiratory volume in 0.5 s, and peak expiratory flow (PEF) were recorded during stepwise dosimetric histamine challenge tests. The responses were compared, and the reproducibility at baseline and from duplicate measurements at each challenge step was determined.

Patients: One hundred five children with newly diagnosed asthma, aged 5 to 10 years.

Results: Compared to PEF, FEV₁ showed better baseline reproducibility (p = 0.002) and higher sensitivity (p < 0.0001) during challenge testing, determined as the change normalized to the baseline variation, while the forced expiratory volumes were not significantly different in these respects. During challenge testing in subjects with acceptable flow-volume tracings, paired recordings of FEV₁ agreed within 0.1 L in 85% and within 0.2 L in 93% of measurements. During challenge testing, the reproducibility of FEV₁ measurements was not better than that of the other indexes. Failure to exhale long enough precluded the use of FEV₁ in 16 of the children, particularly the youngest children.

Conclusions: The results demonstrated that the recently published guidelines for FEV₁ measurements during challenge tests can be applied to children. During challenge tests in asthmatic children, the advantage of the shorter fractions of forced expiratory volume was that they were more often acceptably recorded than FEV₁, while they showed as good reproducibility and were also equally sensitive in assessing changes in airway obstruction.

Key Words: bronchial provocation tests • child • guidelines • reproducibility • respiratory function tests • sensitivity • spirometry

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