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| Content Provider | PubMed Central |
|---|---|
| Author | Thiadens, H. Bock, G. H. De Houwelingen, J. C. Van Dekker, F. Waal, M. W. M. De Springer, M. Postma, D. |
| Abstract | BACKGROUND—In generalpractice airway obstruction and the bronchodilator response are usuallyassessed using peak expiratory flow (PEF) measurements. A study wascarried out in patients presenting with persistent cough to investigateto what extent PEF measurements are reliable when compared with testsusing forced expiratory volume in one second (FEV1) as themeasure of response. METHODS—Data(questionnaire, physical examination, spirometry, PEF) were collectedfrom 240 patients aged 18-75 years, not previously diagnosed withasthma or chronic obstructive pulmonary disease (COPD), who consultedtheir general practitioner with cough of at least two weeks duration.The relationship between low PEF (PEF < PEFpred − 1.64RSD) and lowFEV1 (FEV1 < FEV1pred − 1.64RSD) was tested. A positive bronchodilator response after inhaling 400 µgsalbutamol was defined as an increase in FEV1 of ⩾9%predicted and was compared with an absolute increase in PEF with cutoff values of 40, 60, and 80 l/min and ΔPEF % baseline with cut off values of 10%, 15%, and 20%. RESULTS—Forty eightpatients (20%) had low FEV1, 86 (35.8%) had low PEF, and32 (13.3%) had a positive bronchodilator response. Low PEF had apositive predictive value (PPV) for low FEV1 of 46.5% anda negative predictive value (NPV) of 95%. ΔPEF of ⩾10%, ⩾15%, or ⩾20% baseline had PPVs of 36%, 52%, and 67%, respectively, andΔPEF of ⩾40, ⩾60, and ⩾80 l/min in absolute terms had PPVs of39%, 45%, and 57%, respectively, for ΔFEV1⩾9%predicted; NPVs were high (88-93%). CONCLUSIONS—AlthoughPEF measurements can reliably exclude airway obstruction andbronchodilator response, they are not suitable for use in theassessment of the bronchodilator response in the diagnostic work up ofprimary care patients with persistent cough. The clinical value of PEFmeasurements in the diagnosis of reversible obstructive airway diseaseshould therefore be re-evaluated. |
| Starting Page | 1055 |
| File Format | |
| ISSN | 14683296 |
| e-ISSN | 14683296 |
| Journal | Thorax |
| Issue Number | 12 |
| Volume Number | 54 |
| Language | English |
| Publisher | BMJ Group |
| Publisher Date | 1999-12-01 |
| Access Restriction | Open |
| Rights Holder | BMJ Group |
| Subject Keyword | Research in Higher Education |
| Content Type | Text |
| Resource Type | Article |
| Subject | Pulmonary and Respiratory Medicine |
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