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A literature review of the evidence that a 12% improvement in FEV1 is an appropriate cut-off for children

Abstract Introduction: A well-performed spirometry, using a change in forced expiratory volume in one second (FEV1) after albuterol, is commonly used to support the likelihood of an asthma diagnosis. The current standard, accepted by the 2007 National Heart Lung and Blood Institute Asthma Expert Panel Report-3 (EPR-3) guidelines, is a 12% improvement in the FEV1 after a bronchodilator. Objective: We sought to determine whether existing studies support or refute using a 12% improvement as a significant change in FEV1 in children and adolescents. Data sources: We reviewed the literature of children and adolescents using Medline searches to discover pertinent population studies and comparative studies that included FEV1 measurements. Result: The majority of the discovered studies suggest a less stringent improvement in FEV1 in children might be applicable. Conclusion: Supported by the published literature, we suggest an alternative interpretive strategy of expressing the results of a spirometry measurement when a diagnosis of asthma in a child is being considered using a bronchodilator response.