Correspondence

Forced expiratory flow between 25% and 75% of vital capacity may be a marker of bronchial impairment in allergic rhinitis

Asthma is the most common chronic disease in children and a robust diagnosis is crucial to optimize patient care and reduce its burden. To diagnose asthma in children, the Global Initiative for Asthma (GINA) recommendations propose a 12% improvement in forced expiratory volume in 1 second (FEV₁) after a bronchodilation test. Nevertheless, such a criterion is rarely confirmed in these patients in clinical practice.

The objective of this study was to evaluate the sensitivity of spirometric and clinical parameters in identifying children with possible asthma.

The VERI-VEMS Study is a multicenter international retrospective cohort study. Data were collected, from January 2008 until January 2019, for all consecutive children (aged 5–18 years), with a diagnosis of asthma, who performed a spirometry at the time of the diagnosis. We compared the sensitivity of the reversibility criterion proposed by GINA guidelines, with other spirometric and clinical variables, using physician-diagnosed asthma and response to treatment as the standard.

The study included 871 children. The reversibility criterion of 12% of FEV₁ showed a sensitivity of 30.4%. The 3 best spirometric or clinical criteria were the presence of dry cough, or wheezing or atopy and dry cough, or wheezing or exercise-induced dyspnea, with a sensitivity reaching 99.5%, with no added value of the spirometric parameters in the calculation of the cumulated sensitivity for the diagnosis of pediatric asthma.

Postbronchodilator reversibility of 12%, although essential for patients’ follow-up, has an insufficient low sensitivity in reaching a diagnosis of asthma in pediatric patients, compared with a combination of clinical symptoms, that show a better sensitivity. Further studies on specificity will help clarify the role of this change in the diagnostic paradigm in formally diagnosing children with asthma.

Larynx cancers are among the smoking-related cancers frequently encountered at the head and neck area. Partial surgeries have been preferred in the early-stage larynx cancers during the recent years. Even though partial surgeries are advantageous in terms of protection of the breathing, swallowing, and voice functions, studies regarding the change in the postoperative respiratory functions are not sufficient. Our objective in this study is the scrutiny of the change in the respiratory functions subsequent to various partial surgeries.

Patients who had 34 (10 cordectomy, 7 frontolateral, 9 supraglottic, 8 supracricoid laryngectomy) partial laryngectomy operations and 30 healthy control patients were included in our study. The patients were subject to respiratory function test in the postoperative period and their FEV1, FVC, FEV1/FVC and FEF25–75 values were examined. Data were compared with the healthy control group.

Lower FEF25–75 value (p < 0,05) was observed in the supracricoid laryngectomy patients compared to the control group. In three patients of the supracricoid laryngectomy group, various degrees of restrictive and obstructive findings were observed in the respiratory function test. The least respiratory function change was observed in patients with cordectomy.

In our study, various degrees of restrictive and/or obstructive findings were observed in the respiratory functions after partial surgeries. It was determined that such findings increased as long as the amount of the removed larynx tissue increased. We recommend that patients undergo a respiratory function test after partial laryngectomy and treated according to the findings as restrictive and obstructive findings affect patients' survival.