Persisting airway obstruction in asymptomatic children with asthma with normal peak expiratory flow rates.

Twice-daily symptom scores and peak expiratory flow readings were compared with spirometric values (FEV1 and forced expiratory flow rate between 25% and 75% of FVC [FEF 25-75]) measured at 2-week intervals in assessing airway obstruction in 20 children with asthma studied during 16 weeks. Of 56 2-week periods during which symptoms were absent, peak flow was decreased in 30 (54%), FEV1 in 20 (36%), and FEF 25-75 in 37 periods (66%). Peak flow readings were normal in 13 of 70 periods (16%) in which FEV1 was decreased, and in 33 of 113 periods (29%), in which FEF 25-75 was decreased. Of 25 periods in which symptoms were absent and peak flow was normal, 19 (76%) were associated with decreased FEF 25-75. The results confirm previous studies that indicate peak flow readings are a useful addition to symptom diaries. More importantly, they demonstrate that airway obstruction may be present in a large proportion of asymptomatic children with asthma who have normal peak flow rates and suggest that frequent assessment of FEF 25-75 is required, as well as daily monitoring of symptoms and peak flow both in trials of drug therapy and for more optimal assessment of the effectiveness of therapy in clinical practice.