Leon Csonka, Antti Tikkakoski, Anna P. Tikkakoski, Jussi Karjalainen, Lauri Lehtimäki
{"title":"儿童运动挑战时PEF和FEV1变化的关系。","authors":"Leon Csonka, Antti Tikkakoski, Anna P. Tikkakoski, Jussi Karjalainen, Lauri Lehtimäki","doi":"10.1111/cpf.12864","DOIUrl":null,"url":null,"abstract":"<p>Decrease in forced expiratory volume in one second (FEV<sub>1</sub>) of 10% or 15% in exercise challenge test is considered diagnostic for asthma, but a decrease of 15% in peak expiratory flow (PEF) is recommended as an alternative. Our aim was to assess the accuracy of different PEF cut-off points in comparison to FEV<sub>1</sub>.</p><p>We retrospectively studied 326 free running exercise challenge tests with spirometry in children 6−16 years old. FEV<sub>1</sub> and PEF were measured before and 2, 5, 10 and 15 min after exercise. Receiver operating characteristics (ROC) analysis, sensitivity, specificity, positive and negative predictive values (PPV and NPV) and <i>ϰ</i>-coefficient were used to analyse how decrease in PEF predicts decrease of 10% or 15% in FEV<sub>1</sub>.</p><p>In the ROC analysis, areas under the curve were 0.851 (<i>p</i> < 0.001) and 0.921 (<i>p</i> < 0.001) for PEF decrease to predict a 10% and 15% decrease in FEV<sub>1</sub>, respectively. The agreement between changes in PEF and FEV<sub>1</sub> varied from slight to substantial (<i>ϰ</i> values of 0.199–0.680) depending on the cut-points. Lower cut-off for decrease in PEF had higher sensitivity and NPV, while higher cut-off values had better specificity and PPV. Decrease of 20% and 25% in PEF seemed to be the best cut-offs for detecting 10% and 15% decrease in FEV<sub>1</sub>, respectively. Still, a fifth of the positive findings based on PEF were false.</p><p>Change in PEF is not a precise predictor of change in FEV<sub>1</sub> in exercise test. The currently recommended cut-point of 15% decrease in PEF seems to be too low and leads to high false positive rate.</p>","PeriodicalId":10504,"journal":{"name":"Clinical Physiology and Functional Imaging","volume":null,"pages":null},"PeriodicalIF":1.3000,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cpf.12864","citationCount":"0","resultStr":"{\"title\":\"Relation of changes in PEF and FEV1 in exercise challenge in children\",\"authors\":\"Leon Csonka, Antti Tikkakoski, Anna P. Tikkakoski, Jussi Karjalainen, Lauri Lehtimäki\",\"doi\":\"10.1111/cpf.12864\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p>Decrease in forced expiratory volume in one second (FEV<sub>1</sub>) of 10% or 15% in exercise challenge test is considered diagnostic for asthma, but a decrease of 15% in peak expiratory flow (PEF) is recommended as an alternative. Our aim was to assess the accuracy of different PEF cut-off points in comparison to FEV<sub>1</sub>.</p><p>We retrospectively studied 326 free running exercise challenge tests with spirometry in children 6−16 years old. FEV<sub>1</sub> and PEF were measured before and 2, 5, 10 and 15 min after exercise. Receiver operating characteristics (ROC) analysis, sensitivity, specificity, positive and negative predictive values (PPV and NPV) and <i>ϰ</i>-coefficient were used to analyse how decrease in PEF predicts decrease of 10% or 15% in FEV<sub>1</sub>.</p><p>In the ROC analysis, areas under the curve were 0.851 (<i>p</i> < 0.001) and 0.921 (<i>p</i> < 0.001) for PEF decrease to predict a 10% and 15% decrease in FEV<sub>1</sub>, respectively. The agreement between changes in PEF and FEV<sub>1</sub> varied from slight to substantial (<i>ϰ</i> values of 0.199–0.680) depending on the cut-points. Lower cut-off for decrease in PEF had higher sensitivity and NPV, while higher cut-off values had better specificity and PPV. Decrease of 20% and 25% in PEF seemed to be the best cut-offs for detecting 10% and 15% decrease in FEV<sub>1</sub>, respectively. Still, a fifth of the positive findings based on PEF were false.</p><p>Change in PEF is not a precise predictor of change in FEV<sub>1</sub> in exercise test. The currently recommended cut-point of 15% decrease in PEF seems to be too low and leads to high false positive rate.</p>\",\"PeriodicalId\":10504,\"journal\":{\"name\":\"Clinical Physiology and Functional Imaging\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.3000,\"publicationDate\":\"2023-11-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cpf.12864\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Physiology and Functional Imaging\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1111/cpf.12864\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"PHYSIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Physiology and Functional Imaging","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/cpf.12864","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"PHYSIOLOGY","Score":null,"Total":0}
Relation of changes in PEF and FEV1 in exercise challenge in children
Decrease in forced expiratory volume in one second (FEV1) of 10% or 15% in exercise challenge test is considered diagnostic for asthma, but a decrease of 15% in peak expiratory flow (PEF) is recommended as an alternative. Our aim was to assess the accuracy of different PEF cut-off points in comparison to FEV1.
We retrospectively studied 326 free running exercise challenge tests with spirometry in children 6−16 years old. FEV1 and PEF were measured before and 2, 5, 10 and 15 min after exercise. Receiver operating characteristics (ROC) analysis, sensitivity, specificity, positive and negative predictive values (PPV and NPV) and ϰ-coefficient were used to analyse how decrease in PEF predicts decrease of 10% or 15% in FEV1.
In the ROC analysis, areas under the curve were 0.851 (p < 0.001) and 0.921 (p < 0.001) for PEF decrease to predict a 10% and 15% decrease in FEV1, respectively. The agreement between changes in PEF and FEV1 varied from slight to substantial (ϰ values of 0.199–0.680) depending on the cut-points. Lower cut-off for decrease in PEF had higher sensitivity and NPV, while higher cut-off values had better specificity and PPV. Decrease of 20% and 25% in PEF seemed to be the best cut-offs for detecting 10% and 15% decrease in FEV1, respectively. Still, a fifth of the positive findings based on PEF were false.
Change in PEF is not a precise predictor of change in FEV1 in exercise test. The currently recommended cut-point of 15% decrease in PEF seems to be too low and leads to high false positive rate.
期刊介绍：
Clinical Physiology and Functional Imaging publishes reports on clinical and experimental research pertinent to human physiology in health and disease. The scope of the Journal is very broad, covering all aspects of the regulatory system in the cardiovascular, renal and pulmonary systems with special emphasis on methodological aspects. The focus for the journal is, however, work that has potential clinical relevance. The Journal also features review articles on recent front-line research within these fields of interest.
Covered by the major abstracting services including Current Contents and Science Citation Index, Clinical Physiology and Functional Imaging plays an important role in providing effective and productive communication among clinical physiologists world-wide.
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