Could FEV₁ decline have a role in daily clinical practice for asthma monitoring?

Abstract

Objective:

The aim of this review was to understand whether FEV₁ decline measured during the follow-up of asthmatic subjects (FEV₁ variation between two different measurements at a distance of at least 5 years) may have a role in their management.

Methods:

Articles, commentaries and reviews relating to the topic were searched in PubMed.

Results:

Patients with an accelerated FEV₁ decline (>30 ml/year) may be either steroid-resistant/difficult-to-treat asthmatics or not adequately treated because they are either under-perceivers or poorly adherent to their therapy. Sometimes they may be unable to use devices correctly. Untreated rhinitis and incorrect lifestyle (obesity status, a high-fat diet and lack of exercise) must be considered when facing a pulmonary function decline. Identifying asthmatics with an accelerated FEV₁ decline, even with well controlled symptoms, may allow us to make possible treatment adjustments or to remove potentially harmful environmental exposure and suggest a correct lifestyle. Depending on FEV₁ decline severity, we may detect different asthma phenotypes. One type is characterized by no/low lung function reduction. Among moderate/severe ‘declining’ subjects, there may be a group that might be responsive to treatment and a second one with a quicker loss in lung function that may be unresponsive to therapy.

Conclusion:

FEV₁ decline calculation should be assessed early in clinical practice over the course of time in order to make all possible variations in treatment, environmental exposure and lifestyle more efficacious overall for declining subjects responsive to anti-inflammatory therapy. Further studies are necessary to validate this approach to asthma.

Keywords::

• Asthma
• control
• FEV₁ decline
• management

Transparency

Declaration of funding

This paper has received no funding.

Declaration of financial/other relationships

B.S. has disclosed that he has no significant relationships with or financial interests in any commercial companies related to this study or article.

CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.

Acknowledgment

The author acknowledges Prof. Piero Angelo Lenzi for his professional and linguistic editing.