0
Original Research: ASTHMA |

FEV1 Performance Among Patients With Acute Asthma*: Results From a Multicenter Clinical Trial

Robert A. Silverman, MD; Edith Flaster, MS; Paul L. Enright, MD; Steven G. Simonson, MD, FCCP
Author and Funding Information

*From the Department of Emergency Medicine (Dr. Silverman and Ms. Flaster), Long Island Jewish Medical Center, New Hyde Park, NY; College of Public Health, University of Arizona, Tucson, AZ (Dr. Enright); and AstraZeneca Pharmaceuticals (Dr. Simonson), Wilmington, DE.

Correspondence to: Robert Silverman, MD, Department of Emergency Medicine, Long Island Jewish Medical Center, North-Shore-LIJMC Health Care System, New Hyde Park, NY 11042; e-mail: Aresilv@aol.com



Chest. 2007;131(1):164-171. doi:10.1378/chest.06-0530
Text Size: A A A
Published online

Objective: To determine the ability of patients seen for acute asthma exacerbations in the emergency department (ED) to perform good-quality FEV1 measurements.

Methods: Investigators from 20 EDs were trained to perform spirometry testing as part of a clinical trial that included standardized equipment with special software-directed prompts. Spirometry was done on ED arrival and 30 min, 1 h, 2 h, and 4 h later, and during follow-up outpatient visits.

Measurements: Study performance criteria differed from American Thoracic Society (ATS) guidelines because of the population acuity and severity of illness as follows: ability to obtain acceptable FEV1 measures (defined as two or more efforts with forced expiratory times ≥ 2 s and time to peak flow < 120 ms or back-extrapolated volume < 5% of the FVC) and reproducibility criteria (two highest acceptable FEV1 values within 10% of each other).

Results: Of the 620 patients (age range, 12 to 65 years), > 90% met study acceptability criteria on ED arrival and 74% met study reproducibility criteria. Mean initial FEV1 was 38% of predicted. Spirometry quality improved over time; by 1 h, 90% of patients met study acceptability and reproducibility criteria. Patients with severe airway obstruction (FEV1 < 25% of predicted) were initially less likely to meet quality goals, but this improved with time. The site was also an independent predictor of quality.

Conclusion: When staff are well trained and prompt feedback regarding adequacy of efforts is given, modified ATS performance goals for FEV1 tests can be met from most acutely ill adolescent and adult asthmatics, even within the first hour of evaluation and treatment for an asthma exacerbation.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

CHEST Journal Articles
Estimating FVC From FEV2 and FEV3*: Assessment of a Surrogate Spirometric Parameter
PubMed Articles
Clinical characteristics of eosinophilic asthma exacerbations. Respirology Published online Sep 21, 2016;
Exhaled nitric oxide levels to guide treatment for children with asthma. Cochrane Database Syst Rev Published online Nov 09, 2016;
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543