Chapter title |
Spirometry or Body Plethysmography for the Assessment of Bronchial Hyperresponsiveness?
|
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Chapter number | 204 |
Book title |
Allergy and Respiration
|
Published in |
Advances in experimental medicine and biology, January 2015
|
DOI | 10.1007/5584_2015_204 |
Pubmed ID | |
Book ISBNs |
978-3-31-942003-5, 978-3-31-942004-2
|
Authors |
R. Merget, F. Nensa, E. Heinze, D. Taeger, T. Bruening, Merget, R., Nensa, F., Heinze, E., Taeger, D., Bruening, T. |
Abstract |
Methacholine testing is one of the standard tools for the diagnosis of mild asthma, but there is little information about optimal outcome measures. In this study a total of 395 college students were tested by the ATS dosimeter protocol for methacholine testing, with minor modification. Body plethysmography and spirometry were measured after each inhalation step. The end-of-test-criteria were (i) decrease in forced expiratory volume in 1 s (FEV1) of ≥ 20 % and (ii) doubling of specific airway resistance and its increase to ≥ 2.0 kPa∙s. The results were expressed by receiver operating characteristic (ROC) plots using questionnaire answers as a reference. The areas under the ROC curves were iteratively calculated for a wide range of thresholds for both measures. We found that ROC plots showed maximal sensitivities of about 0.5-0.6 for FEV1 and about 0.7 for specific airway conductance (sGt), with similar specificities of about 0.7-0.8 taking questions with the known high specificity as references. Accordingly, larger maximal areas under the ROC curve were observed for body plethysmography, but the differences were small. A decrease in FEV1 of about 15 % and a decrease of sGt of about 60 % showed the largest areas under the ROC curves. In conclusion, body plethysmography yielded better sensitivity than spirometry, with similar specificity. However, replacing the common spirometric criterium for a positive test (20 % decrease in FEV1 from baseline) by the optimal body plethysmographic criterium would result in an increase of false positive tests from about 4 to 8 % in healthy young adults. |
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