title: Acceptability, reproducibility, and sensitivity of forced expiratory volumes and peak expiratory flow during bronchial challenge testing in asthmatic children.
abstract: OBJECTIVE
  To compare the acceptability, reproducibility, and sensitivity of spirometric outcome measures of airway caliber during challenge testing in children.
  
  
  METHODS
  FEV(1), forced expiratory volume in 0.75 s, forced expiratory volume in 0.5 s, and peak expiratory flow (PEF) were recorded during stepwise dosimetric histamine challenge tests. The responses were compared, and the reproducibility at baseline and from duplicate measurements at each challenge step was determined.
  
  
  METHODS
  One hundred five children with newly diagnosed asthma, aged 5 to 10 years.
  
  
  RESULTS
  Compared to PEF, FEV(1) showed better baseline reproducibility (p = 0.002) and higher sensitivity (p < 0.0001) during challenge testing, determined as the change normalized to the baseline variation, while the forced expiratory volumes were not significantly different in these respects. During challenge testing in subjects with acceptable flow-volume tracings, paired recordings of FEV(1) agreed within 0.1 L in 85% and within 0.2 L in 93% of measurements. During challenge testing, the reproducibility of FEV(1) measurements was not better than that of the other indexes. Failure to exhale long enough precluded the use of FEV(1) in 16 of the children, particularly the youngest children.
  
  
  CONCLUSIONS
  The results demonstrated that the recently published guidelines for FEV(1) measurements during challenge tests can be applied to children. During challenge tests in asthmatic children, the advantage of the shorter fractions of forced expiratory volume was that they were more often acceptably recorded than FEV(1), while they showed as good reproducibility and were also equally sensitive in assessing changes in airway obstruction.
authors.affiliation: Division of Allergology, Helsinki University Central Hospital, Helsinki, Finland. pekka.malmberg@hus.fi
authors.forename: L P
authors.initials: LP
authors.lastname: Malmberg
authors.forename: K
authors.initials: K
authors.lastname: Nikander
authors.forename: A S
authors.initials: AS
authors.lastname: Pelkonen
authors.forename: P
authors.initials: P
authors.lastname: Syvänen
authors.forename: T
authors.initials: T
authors.lastname: Koljonen
authors.forename: T
authors.initials: T
authors.lastname: Haahtela
authors.forename: M
authors.initials: M
authors.lastname: Turpeinen
mesh_terms: D001249:Asthma / Q000175:diagnosis*; D001985:Bronchial Provocation Tests; D002648:Child; D002675:Child, Preschool; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology*; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care; D010366:Peak Expiratory Flow Rate / Q000502:physiology*; D017410:Practice Guidelines as Topic; D015203:Reproducibility of Results; D013147:Spirometry