Stratifying a Risk for an Increased Variation of Airway Caliber among the Clinically Stable Asthma

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  • Hayata Atsushi
    Third Department of Internal Medicine, Wakayama Medical University, School of Medicine Division of Respiratory Disease, Naga Hospital
  • Matsunaga Kazuto
    Third Department of Internal Medicine, Wakayama Medical University, School of Medicine
  • Hirano Tsunahiko
    Third Department of Internal Medicine, Wakayama Medical University, School of Medicine
  • Akamatsu Keiichiro
    Third Department of Internal Medicine, Wakayama Medical University, School of Medicine
  • Ichikawa Tomohiro
    Third Department of Internal Medicine, Wakayama Medical University, School of Medicine
  • Minakata Yoshiaki
    Third Department of Internal Medicine, Wakayama Medical University, School of Medicine
  • Ichinose Masakazu
    Department of Respiratory Disease, Tohoku University Graduate School of Medicine

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Background: Recently, correlations of peak expiratory flow (PEF) variation have been shown to facilitate the prediction of later asthma symptoms and exacerbations. However, it has not been fully examined whether or not any patient characteristics are associated with the residual airway lability in treated asthmatics. The objective of this study is to examine a predictive marker for increased variation of PEF in patients with clinically stable asthma.<br> Methods: We studied 297 asthmatic patients who were monitored for PEF twice a day. Asthma Control Questionnaire (ACQ), spirometry, and exhaled nitric oxide fraction (FENO) were measured. After the assessment of baseline values, PEF measuring was continued and associations between these clinical markers and later variation of PEF over a week (Min%Max) were investigated.<br> Results: 17.5% of the subjects showed increased PEF variability (Min%Max < 80%). ACQ, forced expiratory volume in 1 s % of predicted (%FEV1), and FENO were identified as independent predictors of Min%Max < 80%. An ACQ ≥ 0.4 yielded 96% sensitivity and 59% specificity, a %FEV1 ≤ 85% yielded 62% sensitivity and 89% specificity, and a FENO ≥ 40 ppb yielded 75% sensitivity and 90% specificity for identifying the subjects with high variability in PEF. When we combine %FEV1 ≤ 85% and FENO ≥ 40 ppb, this index showed the highest specificity (98%) for increased PEF variability.<br> Conclusions: These results indicate that ACQ, %FEV1 and FENO can stratify the risk for increased variation in airway caliber among patients with stable asthma. This may help identify subjects in whom further monitoring of lung function fluctuations is indicated.<br>

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