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The initial angle of the maximum expiratory flow-volume curve: a novel start-of-test criteria of spirometry in children

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Abstract

The aim of the present study was to define an initial angle called β and to assess its diagnostic value for identifying poor-quality maneuvers in spirometry testing in children. Furthermore, its predictive equation or normal value was explored. Children aged 4–14 years with respiratory symptoms who underwent spirometry were enrolled. Based on the efforts labeled during maneuvering and the quality control criteria of the guidelines, children were categorized into good-quality and poor-quality groups. According to ventilatory impairment, children in the good-quality group were divided into three subgroups: normal, restricted, and obstructed. Angle β was the angle between the line from the expiratory apex to the origin of coordinates and the x-axis of the maximal expiratory flow-volume (MEFV) curve. Demographic characteristics, angle β, and other spirometric parameters were compared among groups. The diagnostic values of angle β, forced expiratory time (FET), and their combination were assessed using receiver operating characteristic curves. Data from 258 children in the good-quality group and 702 healthy children in our previous study were used to further explore the predictive equation or normal value of angle β. The poor-quality group exhibited a significantly smaller angle β (76.44° vs. 79.36°; P < 0.001), significantly lower peak expiratory flow (PEF), FET, and effective FET (ETe), and significantly higher expiratory volume at peak flow rate (FEV-PEF) and ratio of extrapolated volume and forced vital capacity (EV/FVC) than the good-quality group. There was no significant difference in angle β among the normal, restricted, and obstructed groups. Logistic regression analysis revealed that smaller angle β and FET values indicated poor-quality MEFV curves. The combination of angle β < 74.58° and FET < 4.91 s had a significantly larger area under the curve than either one alone. The normal value of angle β of children aged 4–14 years was 78.40 ± 0.12°.

  Conclusions: Angle β contributes to the quality control evaluation of spirometry in children. Both angle β < 74.58° and FET < 4.91 s are predictors of poor-quality MEFV curves, while their combination offers the highest diagnostic value.

What is Known:

• A slow start is one of the leading causes of poor-quality maximal expiratory flow-volume (MEFV) curves, which is a particularly prominent issue among children due to limited cooperation, especially those younger than 6 years old.

• It is relatively difficult to differentiate between ventilatory dysfunction and poor cooperation when a slow start occurs in children; therefore, there is an urgent need for an objective indicator that is unaffected by ventilatory impairment to evaluate quality control of spirometry.

What is New:

• The initial angle β, which was introduced at the ascending limb of the MEFV curve in the present study, has a certain diagnostic value for poor-quality MEFV curves in children.

• Angle β < 74.58° is a predictor of poor-quality MEFV curves, and its combination with FET < 4.91 s offers a higher diagnostic value.

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All data generated or analyzed during this study are included in this article. Further inquiries can be directed to the corresponding author.

Abbreviations

ATS:

American Thoracic Society

ERS:

European Respiratory Society

ETe:

Effective FET

ETp:

Plateau FET

EV:

Extrapolated volume

FET:

Forced expiratory time

FEV1 :

Forced expiratory volume in 1 s

FEV-PEF:

Expiratory volume at peak flow rate

FVC:

Forced vital capacity

MEFV:

Maximal expiratory flow-volume

PEF:

Peak expiratory flow

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Authors and Affiliations

  1. Department of Pediatrics, Shengjing Hospital of China Medical University, No.36 Sanhao Street, Heping District, Shenyang, Liaoning, 110004, China

    Luanjie Yao, Lingdong Meng, Xin Liu, Xiaowen Li, Fen Liu, Yunxiao Shang & Yong Feng

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Contributions

YLJ, SYX, and FY conceived and designed the study. MLD, LX, LXW, and LF were responsible for the collection and analysis of the experimental data. YLJ and FY interpreted the data and drafted the manuscript which was revised by all authors. All authors contributed to the article and approved the submitted version.

Corresponding author

Correspondence to Yong Feng.

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Ethics approval

Ethical approval was obtained from the Ethics Committee of Shengjing Hospital of China Medical University (approval number: 2022PS073K). This study was conducted in accordance with the principles of the Declaration of Helsinki.

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Written informed consent to participate in this study was provided by the participants’ legal guardian/next of kin.

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Not applicable.

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The authors declare no competing interests.

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Communicated by Peter de Winter

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Yao, L., Meng, L., Liu, X. et al. The initial angle of the maximum expiratory flow-volume curve: a novel start-of-test criteria of spirometry in children. Eur J Pediatr 183, 435–444 (2024). https://doi.org/10.1007/s00431-023-05323-3

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