Am. J. Respir. Crit. Care Med., Volume 159, Number 5, May 1999, 1574-1579

The FEF_25-75/FVC Ratio Is Associated with Methacholine Airway Responsiveness
The Normative Aging Study

AUGUSTO A. LITONJUA, DAVID SPARROW, and SCOTT T. WEISS

Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, and VA Outpatient Clinic, Boston, Massachusetts

Airway responsiveness is known to be partly explained by geometric and anatomic factors. This cross-sectional investigation was undertaken to determine whether FEF_25-75/FVC as a surrogate measure of airway size relative to lung size is associated with airway responsiveness to methacholine. Posteroanterior chest radiographs and spirometry were performed on a group of 929 middle aged and older men from an ongoing longitudinal study, the Normative Aging Study, who returned for their regularly scheduled examination between 1984 and 1989. Subjects had a mean age of 60.5 ± 7.7 yr. FEV₁, FEF_25-75, and FVC were taken from spirometric results and FEF_25-75/FVC ratios were obtained. Main bronchus (MB) and tracheal (TR) diameters and lung area (LA) were obtained from chest radiographs, and ratios of MB/LA and TR/LA were calculated for each subject and compared with FEF_25-75/ FVC as measures of airway size relative to lung size. In a multiple linear regression model adjusting for age, height, initial FEV₁, smoking, eosinophil count, and IgE level, FEF_25-75/FVC was significantly related to the degree of methacholine airway responsiveness as measured by Log₁₀ dose response slope ( = 0.37, p < 0.001). Controlling for the same variables, both MB/LA ( = 149.07, p < 0.001) and TR/LA ( = 125.87, p < 0.001) were significant predictors of the degree of bronchial responsiveness in separate regression models; however, their effects were greatly attenuated when FEF_25-75/ FVC was present in the same model. Similar results were obtained after excluding subjects with FEV₁/ FVC  0.70 and subjects who had any smoking history. We conclude that FEF_25-75/FVC as a surrogate measure of airway size relative to lung size is significantly associated with airway responsiveness.

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