A literature review of the evidence that a 12% improvement in FEV₁ is an appropriate cut-off for children

Abstract

Introduction: A well-performed spirometry, using a change in forced expiratory volume in one second (FEV₁) after albuterol, is commonly used to support the likelihood of an asthma diagnosis. The current standard, accepted by the 2007 National Heart Lung and Blood Institute Asthma Expert Panel Report-3 (EPR-3) guidelines, is a 12% improvement in the FEV₁ after a bronchodilator. Objective: We sought to determine whether existing studies support or refute using a 12% improvement as a significant change in FEV₁ in children and adolescents. Data sources: We reviewed the literature of children and adolescents using Medline searches to discover pertinent population studies and comparative studies that included FEV₁ measurements. Result: The majority of the discovered studies suggest a less stringent improvement in FEV₁ in children might be applicable. Conclusion: Supported by the published literature, we suggest an alternative interpretive strategy of expressing the results of a spirometry measurement when a diagnosis of asthma in a child is being considered using a bronchodilator response.

• Asthma
• bronchodilator tests
• bronchodilator response
• children
• FEV₁
• healthy controls
• non-asthmatic

Acknowledgements

The authors appreciate the valuable suggestions made by Drs. Jeffrey Stokes, Mark Wilson, Paul Feustel and Barbara Bittner.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.