ERS Respiratory Channel

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Abstract

Introduction: The European Respiratory Society (ERS) recommends using the conditional change score to interpret between visit changes in FEV1 in children (Stanojevic, ERJ, 2022). The change score adjusts for the magnitude of FEV1, age and the interval of time between tests. However, the validity of this approach has not been established. The aim of this study was to compare the conditional change score with a fixed cut-off in the relative change in FEV1 percent predicted (FEV1pp) in children with asthma.

Methods: We analyzed acceptable and repeatable FEV1 measurements from 235 children with asthma who were followed at The Hospital for Sick Children in Toronto between April 2019 and October 2022. We calculated between-visit changes in FEV1 using both the conditional change score and the fixed cutoff of +/- 10% FEV1pp, and compared the results. We used percent agreement and the kappa coefficient to assess the agreement between the two approaches in categorizing changes in FEV1 as stable, significantly better, or significantly worse.

Results: We analyzed 490 consecutive measurements with a median time between visits of 133 days. The mean (SD) FEV1 z-score was -0.92 (1.3). Overall, there was strong agreement between the conditional change score and the fixed cutoff of +/- 10% FEV1pp, with a percent agreement of 89.4% and a kappa coefficient of 0.77. The agreement was similar when the threshold for the conditional change score was decreased to +/- 1.65 (agreement 87.6%, kappa 0.77).

Conclusion: In children with asthma, both the conditional change score and a relative change of +/- 10% FEV1pp can both be used to interpret between visit changes in lung function.

Abstract

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