The Clinical Role of Changes of Maximum Expiratory Flow at 25% and 50% of Vital Capacity before and after Bronchodilator Reversibility Test in Diagnosing Asthma

Abstract

Changes of maximum expiratory flow at 25% and 50% of vital capacity (MEF₂₅ and MEF₅₀, respectively), and predominant parameters indicating small airways function in asthmatics before and after bronchodilator (BD) reversibility test have been less interpreted. Our study aimed to investigate the clinical role of changes of MEF₂₅ and MEF₅₀ before and after BD reversibility test in diagnosing asthma. Forced expiratory volume in the first second (FEV₁), MEF₂₅, and MEF₅₀ were measured before and after BD reversibility test in 207 asthmatic patients using standard process. Forty healthy individuals were enrolled as controls. Receiver operating characteristic (ROC) curve was used to assess the diagnostic accuracy of reversibility of MEF₂₅ and MEF₅₀ before and after BD reversibility test (ΔMEF₂₅% and ΔMEF₅₀%, respectively) in diagnosing asthma. Among these functional criteria, ΔMEF₂₅% and ΔMEF₅₀% ≥ 25% performed the best diagnostic performance. The sensitivity, specificity, and accuracy of ΔMEF₂₅% ≥ 25% as an objective diagnostic test for asthma were 63.29%, 87.50%, and 67.21%, and of ΔMEF₅₀% ≥ 25% were 79.23%, 85.00%, and 80.16%, respectively. The area under the ROC curve of the indicators was 0.8203 and 0.9104, respectively. By contrast, an increase in FEV₁ ≥ 12% and 200 mL demonstrated a sensitivity of 62.32%, specificity of 82.50%, and accuracy of 65.59% in diagnosing asthma. The changes of MEF₂₅ and MEF₅₀ before and after BD reversibility test may be of additional value in the clinical diagnosis of asthma, with cutoff values of 25% being the most.

Keywords

asthma / bronchodilator reversibility test / maximum expiratory flow at 25% of vital capacity / maximum expiratory flow at 50% of vital capacity

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