A comparison of spirometric measurements in allergen bronchial challenge testing

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Abstract
The usefulness of several spirometric measurements were compared in detecting asthmatic reactions after allergen bronchial challenge in 14 asthmatic children. All of the children had a history suggesting mite-induced asthma and 11 had a 3 mm or larger diameter weal on prick testing with Dermatophagoides farinae extract. On bronchial challenge testing with dilutions of this extract 12 children had an early asthmatic reaction and 9 had a late asthmatic reaction. In decreasing order of sensitivity for detecting the early asthmatic reaction the tests ranked as follows: FEV1 [forced expiratory volume in 1 s], FEF[forced expiratory flow]50%, FEF25-75%, PEFR [peak expiratory flow rate] and FVC [forced vital capacity]. For the late asthmatic reaction the order was FEF50%, FEV1, FEF25-75%, PEFR and FVC. No single test identified all the early or all the late reactions but the FEV1, a test useful for indicating large airways obstruction, when combined with the FEF25-75%, a test influenced by small airways obstruction, detected all early and late asthmatic reactions. The FEF50% was a sensitive test but was the only 1 to become falsely positive. It became falsely positive in 4 patients. Although the FEV1 was the most useful single test it is, by itself, an inadequate indicator of the asthmatic reaction and should be used with the FEF25-75% to ensure the detection of all asthmatic reactions induced by allergen bronchial challenge testing.

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