Espirometria e teste broncodilatador de crianças portadoras de asma do HCB

Carmen Livia Martins, Julia Furtado e Marcus Jones

comparação classificação espirométrica Equação Brasileira x GLI2012

All subjects (n=468)
Normal-GLI Obstructive-GLI Restrictive/Non-specific-GLI Mixed-GLI
Normal 278 0 5 0
Obstructive 79 67 0 0
Restrictive/Non-specific 6 0 24 0
Mixed 1 0 3 5
Subjects 3 to 9 years (n=234)
Normal-GLI Obstructive-GLI Restrictive/Non-specific-GLI Mixed-GLI
Normal 126 0 0 0
Obstructive 40 42 0 0
Restrictive/Non-specific 6 0 14 0
Mixed 1 0 1 4
Subjects 9 to 12 years (n=234)
Normal-GLI Obstructive-GLI Restrictive/Non-specific-GLI Mixed-GLI
Normal 152 0 5 0
Obstructive 39 25 0 0
Restrictive/Non-specific 0 0 10 0
Mixed 0 0 2 1

Classificação do CVF Equação Brasileira x GLI2012

##           
##            Normal-GLI Mild-GLI Moderate-GLI Severe-GLI
##   Normal          414        8            0          0
##   Mild              8       24            0          0
##   Moderate          0        0           10          0
##   Severe            0        0            2          2

Classificação do VEF1 Equação Brasileira x GLI2012

##           
##            Normal-GLI Mild-GLI Moderate-GLI Severe-GLI
##   Normal          362        1            0          0
##   Mild             25       42            0          0
##   Moderate          0       13           17          0
##   Severe            0        0            4          4

POSD BD

Dados Demográficos: Idade e Altura da amostra

A amostra consiste de 468 crianças asmáticas, sendo que 277 do sexo masculina e 191 do sexo feminino. A idade variou entre 3.62 e 12.99 anos, com uma idade mediana de 9.1. A altura mediana foi de 134 variando de 97 e 187.

##                             Stratified by sexo
##                              Female                  Male                    p      test   
##   n                             191                     277                                
##   Age (years) (median [IQR])   8.93 [7.76, 10.72]      9.20 [7.43, 10.95]     0.493 nonnorm
##   Height (cm) (median [IQR]) 133.00 [123.00, 145.00] 134.00 [125.50, 144.00]  0.447 nonnorm

Histograma idade

Histograma da Altura

Espirometria Basal (Pre BD)

##                               Stratified by sexo
##                                Female            Male              p      test   
##   n                             191               277                            
##   CVF (median [IQR])           1.88 [1.54, 2.28] 2.09 [1.68, 2.40]  0.004 nonnorm
##   VEF1 (median [IQR])          1.66 [1.35, 1.92] 1.69 [1.36, 1.99]  0.197 nonnorm
##   VEF1/CVF (median [IQR])      0.88 [0.83, 0.91] 0.84 [0.78, 0.90] <0.001 nonnorm
##   FEF25-75% (median [IQR])     1.87 [1.48, 2.37] 1.73 [1.38, 2.33]  0.111 nonnorm
##   FEF25-75%/CVF (median [IQR]) 1.03 [0.82, 1.22] 0.86 [0.68, 1.11] <0.001 nonnorm

Espirometria Pos BD

##                                   Stratified by sexo
##                                    Female            Male              p      test   
##   n                                 191               277                            
##   CVF_pos (median [IQR])           1.89 [1.58, 2.30] 2.13 [1.73, 2.48] <0.001 nonnorm
##   VEF1_pos (median [IQR])          1.71 [1.44, 2.04] 1.87 [1.48, 2.16]  0.018 nonnorm
##   VEF1/CVF_pos (median [IQR])      0.91 [0.87, 0.93] 0.87 [0.84, 0.91] <0.001 nonnorm
##   FEF25-75%_pos (median [IQR])     2.29 [1.88, 2.72] 2.21 [1.82, 2.76]  0.403 nonnorm
##   FEF25-75%/CVF_pos (median [IQR]) 1.20 [1.02, 1.40] 1.05 [0.88, 1.22] <0.001 nonnorm

Espirometria: Escore Z

##                              Stratified by sexo
##                               Female               Male                 p      test   
##   n                             191                  277                              
##   cvf_z (median [IQR])        -0.42 [-0.93, 0.22]  -0.30 [-0.99, 0.27]   0.604 nonnorm
##   vef1_z (median [IQR])       -0.72 [-1.48, -0.10] -0.84 [-1.61, -0.18]  0.316 nonnorm
##   vef1cvf_z (median [IQR])    -0.73 [-1.70, 0.02]  -1.01 [-2.12, 0.10]   0.146 nonnorm
##   fef2575_z (median [IQR])    -0.97 [-1.91, -0.04] -1.21 [-2.07, -0.15]  0.325 nonnorm
##   fef2575cvf_z (median [IQR]) -0.51 [-1.34, 0.05]  -0.79 [-1.63, 0.15]   0.211 nonnorm

Espirometria: Resposta ao BD

##                                 
##                                  Overall        
##   n                                 468         
##   Var %CVF Basal (mean (SD))       3.01 (5.65)  
##   Var absoluta CVF (mean (SD))    51.61 (98.14) 
##   Var %CVF previsto (mean (SD))    2.68 (5.14)  
##   Var %VEF1 Basal (mean (SD))      7.54 (8.08)  
##   Var absoluta VEF1 (mean (SD))  117.49 (115.92)
##   Var %VEF1 previsto (mean (SD))   6.33 (6.22)

Resposta ao BD na CVF

percentual do basal, percentual do previsto e absoluto

Female
(N=191)		 Male
(N=277)		 Overall
(N=468)
Var %CVF Basal
Mean (SD) 2.39 (5.49) 3.45 (5.72) 3.01 (5.65)
Median [Min, Max] 1.76 [-17.3, 22.6] 2.21 [-17.2, 40.4] 2.01 [-17.3, 40.4]
Missing 0 (0%) 2 (0.7%) 2 (0.4%)
Var absoluta CVF
Mean (SD) 35.9 (92.4) 62.5 (101) 51.6 (98.1)
Median [Min, Max] 30.0 [-390, 440] 50.0 [-320, 460] 40.0 [-390, 460]
Missing 0 (0%) 2 (0.7%) 2 (0.4%)
Var %CVF previsto
Mean (SD) 2.04 (4.90) 3.12 (5.26) 2.68 (5.14)
Median [Min, Max] 1.73 [-20.5, 18.3] 2.26 [-20.8, 31.7] 1.92 [-20.8, 31.7]
Missing 0 (0%) 2 (0.7%) 2 (0.4%)

Histograma da Resposta ao BD na CVF

Resposta ao BD no VEF1

percentual do basal, percentual do previsto e absoluto

Overall
(N=468)
Var %VEF1 Basal
Mean (SD) 7.54 (8.08)
Median [Min, Max] 6.25 [-15.6, 62.5]
Missing 2 (0.4%)
Var absoluta VEF1
Mean (SD) 117 (116)
Median [Min, Max] 100 [-280, 850]
Missing 2 (0.4%)
Var %VEF1 previsto
Mean (SD) 6.33 (6.22)
Median [Min, Max] 5.64 [-13.2, 35.9]
Missing 2 (0.4%)

Histograma da Resposta ao BD no VEF1

Comparacao da resposta ao BD em meninos e meninas

##                                    Stratified by sexo
##                                     Female                Male                   p      test   
##   n                                   191                    277                               
##   Var %CVF Basal (median [IQR])      1.76 [-0.44, 4.85]     2.21 [0.00, 6.05]     0.050 nonnorm
##   Var absoluta CVF (median [IQR])   30.00 [-10.00, 85.00]  50.00 [0.00, 115.00]   0.011 nonnorm
##   Var %CVF previsto (median [IQR])   1.73 [-0.47, 4.61]     2.26 [0.00, 5.44]     0.043 nonnorm
##   Var %VEF1 Basal (median [IQR])     4.86 [1.49, 9.18]      6.91 [3.18, 11.70]    0.001 nonnorm
##   Var absoluta VEF1 (median [IQR])  80.00 [25.00, 140.00] 120.00 [60.00, 190.00] <0.001 nonnorm
##   Var %VEF1 previsto (median [IQR])  4.46 [1.32, 8.19]      6.25 [2.87, 9.94]     0.001 nonnorm
##                                 Stratified by sexo
##                                  Female        Male            p      test
##   n                                191            277                     
##   Var %CVF Basal (mean (SD))      2.39 (5.49)    3.45 (5.72)    0.046     
##   Var absoluta CVF (mean (SD))   35.86 (92.42)  62.55 (100.65)  0.004     
##   Var %CVF previsto (mean (SD))   2.04 (4.90)    3.12 (5.26)    0.025     
##   Var %VEF1 Basal (mean (SD))     6.16 (7.11)    8.50 (8.58)    0.002     
##   Var absoluta VEF1 (mean (SD))  91.47 (99.90) 135.57 (122.82) <0.001     
##   Var %VEF1 previsto (mean (SD))  5.22 (5.55)    7.10 (6.55)    0.001

Gráficos

Resposta Absoluta ao BD em CVF

Resposta Absoluta ao BD em VEF1

Resposta percentual ao BD em CVF

Resposta percentual ao BD em VEF1

Resposta percentual do previsto ao BD em CVF

Resposta percentual do previsto ao BD em VEF1

Escore Z e reposta ao BD em CVF

Escore Z e reposta ao BD em VEF1

Resposta ao BD na CVF

Overall
(N=468)
Resposta >10% do CVF Basal
No 417 (89.1%)
Yes 49 (10.5%)
Missing 2 (0.4%)
Resposta >10% do CVF Previsto
No 427 (91.2%)
Yes 39 (8.3%)
Missing 2 (0.4%)
Resposta >12% do CVF Basal
No 436 (93.2%)
Yes 30 (6.4%)
Missing 2 (0.4%)
Resposta >150mL do CVF Basal
No 402 (85.9%)
Yes 64 (13.7%)
Missing 2 (0.4%)
Resposta >200mL do CVF Basal
No 434 (92.7%)
Yes 32 (6.8%)
Missing 2 (0.4%)

Resposta ao BD no VEF1

Overall
(N=468)
Resposta >10% do vef1 Basal
No 331 (70.7%)
Yes 135 (28.8%)
Missing 2 (0.4%)
Resposta >10% do vef1 Previsto
No 368 (78.6%)
Yes 98 (20.9%)
Missing 2 (0.4%)
Resposta >12% do vef1 Basal
No 372 (79.5%)
Yes 94 (20.1%)
Missing 2 (0.4%)
Resposta >150mL do vef1 Basal
No 323 (69.0%)
Yes 143 (30.6%)
Missing 2 (0.4%)
Resposta >200mL do vef1 Basal
No 380 (81.2%)
Yes 86 (18.4%)
Missing 2 (0.4%)

Espirometria BASAL Normal (>5 percentil ou escore Z > -1.645)

Overall
(N=468)
CVF dentro dos limites da normalidade
No 46 (9.8%)
Yes 422 (90.2%)
VEF1 dentro dos limites da normalidade
No 105 (22.4%)
Yes 363 (77.6%)
VEF1/CVF dentro dos limites da normalidade
No 155 (33.1%)
Yes 313 (66.9%)

Espirometria POS-BD Normal (>5 percentil ou escore Z > -1.645)

Overall
(N=468)
CVF dentro dos limites da normalidade
No 29 (6.2%)
Yes 437 (93.4%)
Missing 2 (0.4%)
VEF1 dentro dos limites da normalidade
No 50 (10.7%)
Yes 416 (88.9%)
Missing 2 (0.4%)
VEF1/CVF dentro dos limites da normalidade
No 62 (13.2%)
Yes 404 (86.3%)
Missing 2 (0.4%)

ERS/ATS technical standard on interpretive strategies for routine lung function tests

European Respiratory Journal 2022 60: 2101499; DOI: 10.1183/13993003.01499-2021

Classificacao Espirometria BASAL

Overall
(N=468)
Classificação da Espirometria PRÉ-BD
Normal 283 (60.5%)
Obstructive 146 (31.2%)
Restrictive/Non-specific 30 (6.4%)
Mixed 9 (1.9%)

Classificacao Espirometria POS-BD

Overall
(N=468)
Classificação da Espirometria PÓS-BD
Normal 388 (82.9%)
Obstructive 57 (12.2%)
Restrictive/Non-specific 18 (3.8%)
Mixed 5 (1.1%)

Classificacao de Severidade do comprometimento da CVF

Overall
(N=468)
CVF: Classificacao de Severidade
Normal 422 (90.2%)
Mild 32 (6.8%)
Moderate 10 (2.1%)
Severe 4 (0.9%)

Treemap da Classificacao de Severidade do comprometimento do CVF

Classificacao de Severidade do comprometimento do VEF1

Overall
(N=468)
VEF1: Classificacao de Severidade
Normal 363 (77.6%)
Mild 67 (14.3%)
Moderate 30 (6.4%)
Severe 8 (1.7%)

Treemap da Classificacao de Severidade do comprometimento do VEF1

Análses da resposta por grupo

resposta (dicotomica) ao BD por classificação espirométrica: CVF

Normal
(N=283)		 Obstructive
(N=146)		 Restrictive/Non-specific
(N=30)		 Mixed
(N=9)		 Overall
(N=468)
Resposta >10% do CVF Basal
No 261 (92.2%) 129 (88.4%) 23 (76.7%) 4 (44.4%) 417 (89.1%)
Yes 21 (7.4%) 17 (11.6%) 6 (20.0%) 5 (55.6%) 49 (10.5%)
Missing 1 (0.4%) 0 (0%) 1 (3.3%) 0 (0%) 2 (0.4%)
Resposta >10% do CVF Previsto
No 264 (93.3%) 129 (88.4%) 26 (86.7%) 8 (88.9%) 427 (91.2%)
Yes 18 (6.4%) 17 (11.6%) 3 (10.0%) 1 (11.1%) 39 (8.3%)
Missing 1 (0.4%) 0 (0%) 1 (3.3%) 0 (0%) 2 (0.4%)
Resposta >150mL do CVF Basal
No 249 (88.0%) 122 (83.6%) 25 (83.3%) 6 (66.7%) 402 (85.9%)
Yes 33 (11.7%) 24 (16.4%) 4 (13.3%) 3 (33.3%) 64 (13.7%)
Missing 1 (0.4%) 0 (0%) 1 (3.3%) 0 (0%) 2 (0.4%)
Resposta >200mL do CVF Basal
No 270 (95.4%) 132 (90.4%) 26 (86.7%) 6 (66.7%) 434 (92.7%)
Yes 12 (4.2%) 14 (9.6%) 3 (10.0%) 3 (33.3%) 32 (6.8%)
Missing 1 (0.4%) 0 (0%) 1 (3.3%) 0 (0%) 2 (0.4%)

resposta (continua) ao BD por classificação espirométrica: CVF

Normal
(N=283)		 Obstructive
(N=146)		 Restrictive/Non-specific
(N=30)		 Mixed
(N=9)		 Overall
(N=468)
Var %CVF Basal
Mean (SD) 2.82 (5.13) 2.67 (5.87) 4.74 (7.63) 9.18 (6.66) 3.01 (5.65)
Median [Min, Max] 2.02 [-9.63, 40.4] 1.81 [-17.3, 19.2] 4.13 [-7.58, 22.6] 11.7 [1.40, 20.4] 2.01 [-17.3, 40.4]
Missing 1 (0.4%) 0 (0%) 1 (3.3%) 0 (0%) 2 (0.4%)
Var absoluta CVF
Mean (SD) 49.7 (89.6) 48.3 (110) 65.5 (113) 121 (96.1) 51.6 (98.1)
Median [Min, Max] 40.0 [-220, 460] 35.0 [-390, 360] 50.0 [-90.0, 440] 100 [20.0, 280] 40.0 [-390, 460]
Missing 1 (0.4%) 0 (0%) 1 (3.3%) 0 (0%) 2 (0.4%)
Var %CVF previsto
Mean (SD) 2.61 (4.67) 2.52 (5.93) 3.13 (5.21) 6.03 (4.90) 2.68 (5.14)
Median [Min, Max] 1.91 [-10.5, 31.7] 1.80 [-20.8, 19.4] 3.16 [-5.75, 16.3] 5.34 [1.10, 15.7] 1.92 [-20.8, 31.7]
Missing 1 (0.4%) 0 (0%) 1 (3.3%) 0 (0%) 2 (0.4%)

resposta (dicotomica) ao BD por classificação espirométrica: VEF1

Normal
(N=283)		 Obstructive
(N=146)		 Restrictive/Non-specific
(N=30)		 Mixed
(N=9)		 Overall
(N=468)
Resposta >10% do vef1 Basal
No 239 (84.5%) 68 (46.6%) 21 (70.0%) 3 (33.3%) 331 (70.7%)
Yes 43 (15.2%) 78 (53.4%) 8 (26.7%) 6 (66.7%) 135 (28.8%)
Missing 1 (0.4%) 0 (0%) 1 (3.3%) 0 (0%) 2 (0.4%)
Resposta >10% do vef1 Previsto
No 246 (86.9%) 90 (61.6%) 27 (90.0%) 5 (55.6%) 368 (78.6%)
Yes 36 (12.7%) 56 (38.4%) 2 (6.7%) 4 (44.4%) 98 (20.9%)
Missing 1 (0.4%) 0 (0%) 1 (3.3%) 0 (0%) 2 (0.4%)
Resposta >150mL do vef1 Basal
No 232 (82.0%) 62 (42.5%) 25 (83.3%) 4 (44.4%) 323 (69.0%)
Yes 50 (17.7%) 84 (57.5%) 4 (13.3%) 5 (55.6%) 143 (30.6%)
Missing 1 (0.4%) 0 (0%) 1 (3.3%) 0 (0%) 2 (0.4%)
Resposta >200mL do vef1 Basal
No 253 (89.4%) 95 (65.1%) 26 (86.7%) 6 (66.7%) 380 (81.2%)
Yes 29 (10.2%) 51 (34.9%) 3 (10.0%) 3 (33.3%) 86 (18.4%)
Missing 1 (0.4%) 0 (0%) 1 (3.3%) 0 (0%) 2 (0.4%)

resposta (continua) ao BD por classificação espirométrica: VEF1

Normal
(N=283)		 Obstructive
(N=146)		 Restrictive/Non-specific
(N=30)		 Mixed
(N=9)		 Overall
(N=468)
Var %VEF1 Basal
Mean (SD) 4.99 (5.83) 12.1 (8.82) 6.36 (9.76) 16.8 (12.2) 7.54 (8.08)
Median [Min, Max] 4.00 [-13.6, 39.8] 10.7 [-5.04, 62.5] 5.06 [-15.6, 35.8] 18.8 [1.83, 33.3] 6.25 [-15.6, 62.5]
Missing 1 (0.4%) 0 (0%) 1 (3.3%) 0 (0%) 2 (0.4%)
Var absoluta VEF1
Mean (SD) 86.1 (97.6) 181 (121) 90.0 (127) 157 (111) 117 (116)
Median [Min, Max] 80.0 [-280, 580] 165 [-60.0, 850] 70.0 [-70.0, 580] 170 [20.0, 300] 100 [-280, 850]
Missing 1 (0.4%) 0 (0%) 1 (3.3%) 0 (0%) 2 (0.4%)
Var %VEF1 previsto
Mean (SD) 4.56 (5.21) 9.97 (6.45) 4.50 (6.29) 8.50 (5.79) 6.33 (6.22)
Median [Min, Max] 3.82 [-13.2, 33.9] 9.08 [-4.54, 35.9] 3.49 [-6.13, 24.0] 8.98 [0.930, 16.8] 5.64 [-13.2, 35.9]
Missing 1 (0.4%) 0 (0%) 1 (3.3%) 0 (0%) 2 (0.4%)

Normalização da Função Pulmonar após BD

Overall
(N=468)
Normalizacao da Função Pulmonar
Normal: No change 280 (59.8%)
Normalization of lung function 108 (23.1%)
Abnormal: No change 77 (16.5%)
Normal before, Abnormal after BD 3 (0.6%)
Normal
(N=283)		 Obstructive
(N=146)		 Restrictive/Non-specific
(N=30)		 Mixed
(N=9)		 Overall
(N=468)
Normalizacao da Função Pulmonar
Normal: No change 280 (98.9%) 0 (0%) 0 (0%) 0 (0%) 280 (59.8%)
Normalization of lung function 0 (0%) 96 (65.8%) 11 (36.7%) 1 (11.1%) 108 (23.1%)
Abnormal: No change 0 (0%) 50 (34.2%) 19 (63.3%) 8 (88.9%) 77 (16.5%)
Normal before, Abnormal after BD 3 (1.1%) 0 (0%) 0 (0%) 0 (0%) 3 (0.6%)

Classificacao da Espirometria BASAL

Classificacao da Espirometria PÓS-BD

Explorando FEF25-75/CVF

##                                   Stratified by sexo
##                                    Female              Male                p      test   
##   n                                  191                 277                             
##   FEF25-75%/CVF (median [IQR])      1.03 [0.82, 1.22]   0.86 [0.68, 1.11]  <0.001 nonnorm
##   fef2575cvf_z (median [IQR])      -0.51 [-1.34, 0.05] -0.79 [-1.63, 0.15]  0.211 nonnorm
##   FEF25-75%/CVF_pos (median [IQR])  1.20 [1.02, 1.40]   1.05 [0.88, 1.22]  <0.001 nonnorm
##   fef2575cvf_z_pos (median [IQR])  -0.03 [-0.55, 0.49] -0.08 [-0.74, 0.54]  0.588 nonnorm
##   delta_fef2575 (median [IQR])      0.74 [0.35, 1.38]   0.88 [0.42, 1.49]   0.072 nonnorm
##   delta_vef1 (median [IQR])         0.35 [0.11, 0.64]   0.52 [0.24, 0.86]  <0.001 nonnorm
##   delta_cvf (median [IQR])          0.12 [-0.03, 0.33]  0.16 [0.00, 0.43]   0.024 nonnorm
##                                   
##                                    Overall            
##   n                                  468              
##   FEF25-75%/CVF (median [IQR])      0.94 [0.73, 1.15] 
##   fef2575cvf_z (median [IQR])      -0.69 [-1.52, 0.09]
##   FEF25-75%/CVF_pos (median [IQR])  1.11 [0.93, 1.31] 
##   fef2575cvf_z_pos (median [IQR])  -0.06 [-0.67, 0.53]
##   delta_fef2575 (median [IQR])      0.83 [0.41, 1.42] 
##   delta_vef1 (median [IQR])         0.47 [0.19, 0.79] 
##   delta_cvf (median [IQR])          0.14 [0.00, 0.39]

comparando a classificação das espirometrias pela equação brasileira e por GLI 2012

##                           
##                            Normal-GLI Obstructive-GLI Restrictive/Non-specific-GLI Mixed-GLI
##   Normal                          278               0                            5         0
##   Obstructive                      79              67                            0         0
##   Restrictive/Non-specific          6               0                           24         0
##   Mixed                             1               0                            3         5

Comparação de classificação das espirometrias por euqcao brasileira e por GLI 2012

VEF1

##           
##            Normal-GLI Mild-GLI Moderate-GLI Severe-GLI
##   Normal          362        1            0          0
##   Mild             25       42            0          0
##   Moderate          0       13           17          0
##   Severe            0        0            4          4

CVF

##           
##            Normal-GLI Mild-GLI Moderate-GLI Severe-GLI
##   Normal          414        8            0          0
##   Mild              8       24            0          0
##   Moderate          0        0           10          0
##   Severe            0        0            2          2

criando boxplot de funcao pulmonar

Z scores Equação brasileira

Z scores equação GLI Caucasiana