title: Role of forced expiratory flow at 25-75% as an early marker of small airways impairment in subjects with allergic rhinitis.
abstract: A close link exists between allergic rhinitis and asthma. Small airway disease (SAD), defined by a reduction in forced expiratory flow at 25-75% of the pulmonary volume (FEF25-75) and normal spirometry (normal forced expiratory volume at 1 second [FEV1], forced vital capacity [FVC], and FEV1/FVC ratio), may be a marker for early allergic or inflammatory involvement of the small airways in subjects with allergic diseases and no asthma. The aim of this study was to determine if there is a relationship between SAD, the outcome variable, and several allergic predictors in patients without asthma but with allergic rhinitis. A cross-sectional study was performed. Two hundred eleven midshipmen attending the third and fifth course of the Navy Academy of Livorno were screened. Fifty-eight midshipmen showed slight spirometric anomalies. Thus, they were referred to the Navy Hospital of La Spezia for standardized tests: skin-prick test, nasal cytology, spirometry, and methacholine bronchial challenge. A reduced FEF(25-75) was arbitrarily defined as < 80% of predicted. All 58 subjects had a normal FEV1, FVC, and FEV1/FVC ratio. Twenty subjects had a reduced FEF(25-75), consistent with the definition of SAD. A mean value of FEF(25-75) of 70.3 (SD, 8.5) was measured in patients with a reduced FEF, and it was 108.0 (SD, 14.3) in patients with preserved FEF(25-75). All the candidate allergic predictors appeared to be strongly associated with a reduced FEF(25-75). The proportion of subjects with reduced FEF(25-75) appeared to increase with increasing severity of the allergic predictors, and, correspondingly, the mean value of FEF(25-75) appeared to decrease. This study provides evidence that there is a relationship between SAD and allergic parameters such as nasal symptoms and eosinophils.
authors: Department of Pediatrics, IRCCS Policlinico San Matteo, University of Pavia, Italy. gl.marseglia@smatteo.pv.it
authors: Gian Luigi
authors: GL
authors: Marseglia
authors: Ignazio
authors: I
authors: Cirillo
authors: Andrea
authors: A
authors: Vizzaccaro
authors: Catherine
authors: C
authors: Klersy
authors: Maria Angela
authors: MA
authors: Tosca
authors: Mario
authors: M
authors: La Rosa
authors: Alessia
authors: A
authors: Marseglia
authors: Amelia
authors: A
authors: Licari
authors: Maddalena
authors: M
authors: Leone
authors: Giorgio
authors: G
authors: Ciprandi
mesh_terms: D000328:Adult; D000403:Airway Resistance; D016535:Bronchial Hyperreactivity / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology*; D001985:Bronchial Provocation Tests; D003430:Cross-Sectional Studies; D004804:Eosinophils / Q000473:pathology; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007558:Italy; D008297:Male; D008450:Maximal Midexpiratory Flow Rate; D009297:Nasal Mucosa / Q000473:pathology; D011237:Predictive Value of Tests; D012130:Respiratory Hypersensitivity / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology*; D012137:Respiratory System / Q000473:pathology / Q000503:physiopathology*; D012221:Rhinitis, Allergic, Perennial / Q000473:pathology / Q000503:physiopathology*; D006255:Rhinitis, Allergic, Seasonal / Q000473:pathology / Q000503:physiopathology*; D012720:Severity of Illness Index; D012882:Skin Tests; D013147:Spirometry; D014797:Vital Capacity