Is an FEV 1 of 80% predicted a normal spirometry in cystic fibrosis children and adults?

FEV is considered the gold standard spirometric measure for the assessment and management of cystic fibrosis lung disease. Recent evidence suggests that tests at lower lung volumes may be more sensitive. To assess how many other spirometric tests are abnormal in the presence of a normal FEV (≥80%) a...

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Bibliographic Details
Published in:The clinical respiratory journal 2018-08, Vol.12 (8), p.2397-2403
Main Authors: König, Peter, Ner, Zarah, Acton, James D, Ge, Bin, Hewett, John
Format: Article
Language:English
Subjects:
Adolescent
Adult
Airway Obstruction - physiopathology
Child
Cystic Fibrosis - physiopathology
Female
Forced Expiratory Volume - physiology
Humans
Lung - pathology
Lung - physiopathology
Male
Middle Aged
Respiratory Function Tests - instrumentation
Retrospective Studies
Sensitivity and Specificity
Spirometry - standards
Young Adult
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Summary:FEV is considered the gold standard spirometric measure for the assessment and management of cystic fibrosis lung disease. Recent evidence suggests that tests at lower lung volumes may be more sensitive. To assess how many other spirometric tests are abnormal in the presence of a normal FEV (≥80%) and which spirometric tests are most sensitive in detecting airway obstruction. This was a retrospective analysis of 3169 spirometry tests on 184 patients with cystic fibrosis aged 6-57 years. Tests were acceptable if they met ATS criteria. Tests with normal FEV , FEF showed obstruction in 58% of tests, FEF in 31% and FEV /FVC ratio in 72%. Overall 75% of tests had an abnormality. FEF , FEF , FEF and FEV /FVC ratio were all significantly more sensitive in identifying obstruction than FEV . The FEV /FVC ratio was the most sensitive of all tests in identifying obstruction except in adults (> 20 years), in whom FEF at 90%, was more sensitive than the ratio at 85%. FEF was also at 85% sensitive. Even though the FEV /FVC ratio was the most sensitive of all tests, in the presence of a normal ratio, 35% other tests were abnormal. Normal FEV , is not indicative of normal spirometry. FEV /FVC is the most sensitive measure of early or mild airway obstruction in children with cystic fibrosis. If only the FEV /FVC ratio was considered, many cases of obstruction would be missed, therefore all spirometric measures should be considered in the clinical evaluation of airway obstruction.
ISSN:1752-6981
1752-699X
DOI:10.1111/crj.12920