Can peak expiratory flow measurements reliably identify the presence of airway obstruction and bronchodilator response as assessed by FEV1 in primary care patients presenting with a persistent cough?

Thiadens, HA; Bock, Geertruida H. de; Houwelingen, Hans C. van; Dekker, Friedo W.; Waal, Margot W. M. de; Springer, M. P.; Postma, Dirkje S.

doi:10.1136/thx.54.12.1055

Cited by 63 publications

(46 citation statements)

References 13 publications

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“…In general, results showed high specificites, but low sensitivities and positive predictive values. 8 The highest positive predictive value of 83% was found with ∆PEF% increment of 20% against an absolute FEV 1 increase of 200 mL. In another study on 176 children with asthma, ∆PEF% of 20% or 25% had a high specificity (96% and 96%, respectively), but moderate sensitivity (51% and 53%, respectively), in identifying BDR (defined as a 9% increase in FEV 1% predicted after inhalation of 800mcg salbutamol).…”

Section: O P Y R I G H T G P I a Gmentioning

confidence: 97%

“…Although we understand the limitations and bias of such a retrospective analysis, and we are hampered by the lack of complete clinical details for all patients, the large number of subjects studied still provides much more precise results compared to those achieved by previous investigators. [6][7][8][9] In addition, we based our analysis on PEF values corrected for non-linearity of the PEF meter. Therefore the results have a wider applicability in light of the new European standards introduced in 2004.…”

Section: O P Y R I G H T G P I a Gmentioning

confidence: 99%

“…Some data suggest that, although lack of responsiveness in PEF can be used to exclude BDR, it is of much less value as a diagnostic test. 8,9 We therefore studied adult patients undergoing BDR testing to evaluate the performance of PEF measurement as an alternative to spirometry in diagnosing BDR.…”

Section: Introductionmentioning

confidence: 99%

“…A few investigators have studied this previously in both adults and children. [6][7][8][9] However, these studies were conducted on small numbers of selected patients, and variable criteria were used to define BDR, making interpretation and comparison difficult. Some data suggest that, although lack of responsiveness in PEF can be used to exclude BDR, it is of much less value as a diagnostic test.…”

Section: Introductionmentioning

confidence: 99%

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Use of peak expiratory flow for assessing bronchodilator responsiveness

Aggarwal

Agarwal

Gupta

et al. 2008

Primary Care Respiratory Journal

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Lung function in 1686 adult patients was measured before, and 15 minutes after, salbutamol inhalation. Bronchodilator responsiveness (BDR) was defined as a 12% improvement over baseline in either FEV1 or FVC, along with an absolute volume increment of 200ml. Peak expiratory flow (PEF) change, both absolute and relative to baseline, was also calculated (∆PEF and ∆PEF%, respectively). Change in PEF significantly correlated with change in FEV1. However, ∆PEF and ∆PEF% had poor discrimination in identifying BDR, with all specific cutoff values for ∆PEF and ∆PEF% having low or moderate sensitivity, specificity and predictive values.

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Section: O P Y R I G H T G P I a Gmentioning

confidence: 97%

Section: O P Y R I G H T G P I a Gmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Use of peak expiratory flow for assessing bronchodilator responsiveness

Aggarwal

Agarwal

Gupta

et al. 2008

Primary Care Respiratory Journal

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“…Peak flow, especially measured with peak-flow meters, has not been found to perform comparably with FEV1 in diagnosing and categorising COPD [16]. Peak flow is more effort-dependent than FEV1 and peak-flow meters have significant interinstrument variability.…”

Section: Methods Of Assessing Airflow Limitation: Current Recommendatmentioning

confidence: 99%

Airway inflammation in COPD: physiological outcome measures and induced sputum

Crapo

Jensen²,

Hargreave³

2003

Eur Respir J

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Chronic obstructive pulmonary disease (COPD) is a result of airway inflammation, and the best predictor of COPD is the early detection of airflow limitation by spirometry. The Global Initiative for Obstructive Lung Disease Workshop Report defines airflow limitation using simple spirometric indices. Available guidelines categorise the severity of COPD using forced expiratory volume in one second (FEV1) and forced vital capacity (FVC), with symptoms playing a minor role in the assessment.Current standards define COPD by progressive loss of FEV1, and thus longitudinal decline in FEV1 will be the primary outcome variable for intervention studies aimed at preventing or reducing the loss of pulmonary function. There is evidence, however, that the variable FEV1/FVC and FEV1 are often not measured properly in all settings.This article will discuss the roles of physiological measurements in diagnosing COPD and physiological outcome measures for COPD. It does not formally compare physiological measures with other outcome measures, such as symptoms or quality of life. Additionally, improved treatment of established disease requires a better understanding of the inflammatory process and its clinical effects and treatment.The inflammatory process, and how drugs affect it, can be studied noninvasively or relatively noninvasively by using refined methods of examining spontaneous or induced sputum. Enhanced understanding of the use of induced sputum will assist in predicting patients9 responses to short-and long-term inhaled corticosteroid treatment, and the methods of sputum examination need to be simplified so that they can be applied more easily to clinical practice. Eur Respir J 2003; 21: Suppl. 41, 19s- Chronic obstructive pulmonary disease (COPD) is defined by the Global Initiative for Obstructive Lung Disease (GOLD) as a "disease state characterised by airflow limitation that is not fully reversible. …The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases" [1]. The absence of reversibility tends to exclude asthma by definition, although asthma can coexist with COPD. Methods of assessing airflow limitation: current recommendations and their limitationsAvailable guidelines categorise the severity of COPD primarily by using forced expiratory volume in one second (FEV1), whereas symptoms play a minor role in the assessment [1][2][3][4][5]. This tight link between FEV1 and COPD reflects the fact that spirometry is the standard for defining the presence of airway obstruction and the progressive loss of FEV1, the physiological variable that characterises COPD severity and predicts its mortality. Spirometry has become the standard, in part, because good quality and inexpensive tests are widely available.The GOLD Workshop Report explicitly defines airflow limitation using simple spirometric indices. Specifically, airflow limitation is defined as an FEV1/forced vital capacity (FVC)v70% and a postbronchodilator FEV1v80% of predict...

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Clinical Assessment of Cough

McGarvey¹

2003

Cough: Causes, Mechanisms and Therapy

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Can peak expiratory flow measurements reliably identify the presence of airway obstruction and bronchodilator response as assessed by FEV1 in primary care patients presenting with a persistent cough?

Cited by 63 publications

References 13 publications

Use of peak expiratory flow for assessing bronchodilator responsiveness

Use of peak expiratory flow for assessing bronchodilator responsiveness

Airway inflammation in COPD: physiological outcome measures and induced sputum

Clinical Assessment of Cough

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