The full content of Annals is available to subscribers

Subscribe/Learn More  >
Original Research |

Wheezing on Maximal Forced Exhalation in the Diagnosis of Atypical Asthma: Lack of Sensitivity and Specificity

Dennis K. King, MD; B. Taylor Thompson, MD; and Douglas C. Johnson, MD
[+] Article, Author, and Disclosure Information

Grant Support: Dr. King was supported by NIH training grant HL-07354 and Dr. Johnson was supported by NHLBI Clinical Investigator Award HL-Ol 166.

Current Author Addresses: Dr. King: Sarno Professional Building, Suite C, 1370 Sarno Road, Melbourne, FL 32935.

Drs. Thompson and Johnson: Massachusetts General Hospital, Pulmonary Unit, Bulfinch 1, Fruit Street, Boston, MA 02114.

©1989 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1989;110(6):451-455. doi:10.7326/0003-4819-110-6-451
Text Size: A A A

Study Objective: To determine whether wheezing on maximal forced exhalation is a predictor of asthma in persons with normal or nearly normal baseline spirometry.

Design: Prospective study of patients referred for methacholine challenge testing.

Setting: Pulmonary function laboratory at a hospital.

Patients: Forty-four patients referred for methacholine challenge testing because of the clinical suspicion of cough variant or otherwise difficult to diagnose asthma, with normal or nearly normal baseline spirometry and without wheezing on routine lung auscultation during quiet breathing.

Interventions: We listened for wheezing on maximal forced exhalation. Wheezing was defined as a continuous sound with a musical quality. Methacholine challenge testing was done. The concentration of methacholine required to produce a 20% fall in baseline FEV1 (PC20) of less than 8 mg/mL was considered a positive test for asthma.

Measurements and Main Results: Wheezing was present on maximal forced exhalation in 8 of 14 patients with a positive methacholine challenge test (sensitivity = 57%) and absent in 11 of 30 patients with a negative test (specificity = 37%). Furthermore, wheezing on maximal forced exhalation was present in 13 of 27 patients with a PC20 greater than 16 mg/mL and absent in 2 of 7 with a PC20 less than 4 mg/mL.

Conclusions: Wheezing on maximal forced exhalation is neither sensitive nor specific for airway hyperreactivity.





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $42.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.