Reconsidering isolated FEV₁ reduction: A case report of early-stage asthma with bronchial hyperreactivity and literature review

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Published Dec 27, 2025
https://doi.org/10.62438/tunismed.v103i10.6028
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Vol. 103 No. 10 (2025): Tunis Med Oct 2025

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Saba Boubakri
Laboratory of Physiology and Functional Explorations, Sousse, Farhat Hached Hospital, Faculty of Medicine of Sousse, University of Sousse, Tunisia.
Balsam Barkous
Laboratory of Physiology and Functional Explorations,Heart Failure (LR12SP09) Research Laboratory, Farhat Hached Hospital, Sousse, of Medicine of Sousse, University of Sousse, Tunisia.
https://orcid.org/0009-0005-3173-8889
Nadia Ben Lazreg
Laboratory of Physiology and Functional Explorations,Heart Failure (LR12SP09) Research Laboratory, Farhat Hached Hospital, Sousse, of Medicine of Sousse, University of Sousse, Tunisia.
https://orcid.org/0009-0002-4874-9582
Imen Talbi
Laboratory of Physiology and Functional Explorations, Sousse, Farhat Hached Hospital, Faculty of Medicine of Sousse, University of Sousse, Tunisia
https://orcid.org/0009-0000-5807-6575
Maimouna Touré
Laboratory of Human Physiology and Functional Explorations, Faculty of Medicine, Pharmacy and OdontoStomatology (FMPOS) University of Cheikh Anta Diop (UCAD), Dakar, SENEGAL
https://orcid.org/0000-0003-1954-0210
Helmi Ben Saad
Laboratory of Physiology and Functional Explorations,Heart Failure (LR12SP09) Research Laboratory, Farhat Hached Hospital, Sousse, of Medicine of Sousse, University of Sousse.International Center of Functional Explorations, Sousse, Tunisia.
https://orcid.org/0000-0002-7477-2965

Abstract

Introduction: Isolated low forced expiratory volume in one second (FEV1) spirometric impairment (ILFSI) is characterized by a decreased FEV1 while both forced vital capacity (FVC) and the FEV1/FVC ratio remain within normal ranges. This pattern may hide an underlying respiratory disorder that warrants further examination. Notably, the 2022 European respiratory society/American thoracic society (2022-ERS/ATS) guidelines do not classify ILFSI as pathological, a stance that has sparked some controversy. This teaching report discussed the case of a woman with ILFSI who developed mild bronchial hyperreactivity after undergoing a methacholine bronchial challenge test (MBCT) and exhibited positive skin prick tests (SPTs) for dust mites.


Observation: A 28-year-old professional interior designer, who has no history of smoking or exposure to wood smoke and allergens, and who previously experienced a mild case of coronavirus disease-2019, consulted a pulmonologist for chronic cough, sputum production, and recurrent sneezing episodes. Asthma was suspected, leading to the performance of SPTs, spirometry, and either a bronchodilator test (in case of an obstructive ventilatory impairment) or MBCT (in case of a normal spirometry) as requested in the pulmonologist referral letter. The spirometry results indicated ILFSI, with a low FEV1 (z-score = -1.74, 79%) while FVC (z-score = -0.97, 88%) and the FEV1/FVC ratio (z-score = -1.35) remained normal. According to the 2022-ERS/ATS guidelines, these findings are considered normal spirometry because of the maintained FVC and FEV1/FVC ratio. The MBCT confirmed mild bronchial hyperreactivity, showing a 20% drop in FEV1 at a dose of 96 µg. Furthermore, SPTs were positive for dust mites (Dermatophagoides pteronyssinus and farinae).


Conclusion: The results of this report suggested a possible association between ILFSI and early allergic asthma, indicating that ILFSI should be re-examined in future revisions of the 2022-ERS/ATS guidelines for interpreting spirometric tests.

Keywords:

Algorithm, Bronchial Provocation Tests, Case Report, Cough, Guideline, Nonspecific Pattern, Pulmonary Function Tests, Respiratory Hypersensitivity

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Author Biography

Helmi Ben Saad, Laboratory of Physiology and Functional Explorations,Heart Failure (LR12SP09) Research Laboratory, Farhat Hached Hospital, Sousse, of Medicine of Sousse, University of Sousse.International Center of Functional Explorations, Sousse, Tunisia.

  • Professor of Physiology and Functional Explorations at the Faculty of Medicine of Sousse - Tunisia, Department of Physiology and Functional Explorations at EPS Farhat HACHED - Sousse - Tunisia.
  • President of the College of Physiology and Functional Explorations (terms: 2014-2017 and 2021-2023).
  • Master's degree in Biological and Medical Sciences from the University of Montpellier I, France.
  • World expert in spirometry (ranked 1st in Africa): https://expertscape.com/ex/spirometry/c/afr.
  • Diploma of Advanced Studies in "Human Movement Sciences" from the University of Montpellier I, France.
  • Interuniversity Diploma "Pathophysiology of Exercise and Functional Exercise Explorations" from the University of Montpellier 1, France.
  • International PhD in Sciences between the Universities of Montpellier I (France) and Monastir (Tunisia).
  • European Spirometry Driving License Part 1 (theory only) and the European Spirometry Training Program (Part 2: knowledge and competence in practice) and the European Spirometry train-the-trainer course.
  • Invited speaker at numerous international congresses on respiratory functional explorations.
  • Author of over 250 scientific articles in indexed and impact factor journals.
  • Potential reviewer for over 100 indexed and impact factor journals and potential external reviewer for the University of Cape Town (South Africa), uwait (Kuwait) and Mutah (Jordan).
  • Winner of the Sadok BESROUR Award for Excellence in Medical Research (2021).
  • Web:
  1. http://scholar.google.fr/citations?hl=fr&user=oeV_0OwAAAAJ&view_op=list_works&sortby=pubdatehttp://www.researchgate.net/profile/Helmi_Ben_Saad
  2. https://publons.com/author/602231/helmi-ben-saad#profile
  3. https://www.researchgate.net/profile/Helmi_Ben_Saad

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