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How to interpret reduced forced expiratory volume in 1 s (FEV₁)/vital capacity ratio with normal FEV₁

¹ Unità Operativa (U.O.) Medicina Preventiva e del Lavoro, Laboratorio di Fisiopatologia Respiratoria, ² U.O. Fisiopatologia Respiratoria, Dipartimento di Medicina Interna, Università di Genova, Azienda Ospedaliera Universitaria "San Martino", Genova, and ³ Centro di Fisiopatologia Respiratoria e dello Studio della Dispnea, Azienda Ospedaliera S.Croce e Carle, Cuneo, Italy.

CORRESPONDENCE: G. Barisione, U.O. Medicina Preventiva e del Lavoro, Laboratorio di Fisiopatologia Respiratoria, Azienda Ospedaliera Universitaria, San Martino, Largo Rosanna Benzi 10, 16132 Genova, Italy. Fax: 39 105556667. E-mail: giovanni.barisione{at}hsanmartino.it

Keywords: Atopic rhinitis, bronchial asthma, chronic obstructive pulmonary disease, dysanaptic lung growth, methacholine challenge, single-breath nitrogen wash-out

Received: December 3, 2008
Accepted January 19, 2009

The aim of the present study was to determine whether the combination of low forced expiratory volume in 1 s (FEV₁)/vital capacity (VC) ratio with normal FEV₁ represents a physiological variant or a sign of early airflow obstruction.

We studied 40 subjects presenting with low FEV₁/VC, but FEV₁ within the range of normality predicted by European Respiratory Society reference equations, and 10 healthy controls. All subjects completed two questionnaires and underwent comprehensive pulmonary function testing, which included methacholine challenge and single-breath nitrogen wash-out.

According to the questionnaires, the subjects were assigned to three groups, i.e. rhinitis (n = 8), bronchial asthma (n = 13) and chronic obstructive pulmonary disease (COPD; n = 12). Subjects with negative responses to questionnaires were assigned to an asymptomatic group (n = 7). Airway hyperresponsiveness was found in four subjects of the rhinitis group, all of the asthma group, and 10 of the COPD group; in the last two groups, it was associated with signs of increased airway closure and gas trapping. Bronchodilator response to salbutamol was positive in only a few individuals across groups. In the asymptomatic group, no significant functional changes were observed, possibly suggesting dysanaptic lung growth.

In subjects with low FEV₁/VC and normal FEV₁, questionnaires on respiratory symptoms together with additional pulmonary function tests may help to clarify the nature of this pattern of lung function.