Can a normal peak expiratory flow exclude severe chronic obstructive pulmonary disease?

Rogelio Perez-Padilla, W. M. Vollmer, J. C. Vázquez-García, P. L. Enright, A. M B Menezes, A (Sonia) Buist

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is underdiagnosed. One barrier to diagnosis is the limited availability of spirometry testing, but in adults at risk for COPD, a normal pre-bronchodilator (pre-BD) peak expiratory flow (PEF) may rule out clinically significant COPD. OBJECTIVE: To identify post-BD airway obstruction using data from 13 708 individuals aged ≥40 years from the PLATINO and BOLD studies. METHODS: We evaluated different cut-off points of pre-BD. The PEF was obtained from a diagnostic-quality spirometer (not a mechanical PEF meter). At least one of the following COPD risk factors was present in 77% of the subjects: chronic respiratory symptoms; exposure to tobacco smoke, biomass smoke or dust in the workplace; or a previous diagnosis of asthma, COPD, emphysema or chronic bronchitis. RESULTS: Although the positive predictive value was low as expected, a pre-BD PEF of ≥70% predicted effectively ruled out Stages III and IV COPD of the Global Initiative for Chronic Obstructive Lung Disease. Among those with at least one risk factor, only 12% would require confirmatory spirometry using this criterion. CONCLUSIONS: Adding PEF measurement to a screening questionnaire may rule out severe to very severe COPD without the need for pre- and post-BD spirometry testing. Confirmation is needed from a study using inexpensive PEF meters or pocket spirometers with a staged screening protocol.

Original languageEnglish (US)
Pages (from-to)387-393
Number of pages7
JournalInternational Journal of Tuberculosis and Lung Disease
Volume13
Issue number3
StatePublished - Mar 2009

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Chronic Obstructive Pulmonary Disease
Bronchodilator Agents
Spirometry
Smoke
Pulmonary Emphysema
Chronic Bronchitis
Airway Obstruction
Dust
Workplace
Biomass
Tobacco
Asthma

Keywords

  • BOLD
  • COPD
  • PEF
  • PLATINO
  • Screening

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Infectious Diseases

Cite this

Perez-Padilla, R., Vollmer, W. M., Vázquez-García, J. C., Enright, P. L., Menezes, A. M. B., & Buist, A. S. (2009). Can a normal peak expiratory flow exclude severe chronic obstructive pulmonary disease? International Journal of Tuberculosis and Lung Disease, 13(3), 387-393.

Can a normal peak expiratory flow exclude severe chronic obstructive pulmonary disease? / Perez-Padilla, Rogelio; Vollmer, W. M.; Vázquez-García, J. C.; Enright, P. L.; Menezes, A. M B; Buist, A (Sonia).

In: International Journal of Tuberculosis and Lung Disease, Vol. 13, No. 3, 03.2009, p. 387-393.

Research output: Contribution to journalArticle

Perez-Padilla, R, Vollmer, WM, Vázquez-García, JC, Enright, PL, Menezes, AMB & Buist, AS 2009, 'Can a normal peak expiratory flow exclude severe chronic obstructive pulmonary disease?', International Journal of Tuberculosis and Lung Disease, vol. 13, no. 3, pp. 387-393.
Perez-Padilla R, Vollmer WM, Vázquez-García JC, Enright PL, Menezes AMB, Buist AS. Can a normal peak expiratory flow exclude severe chronic obstructive pulmonary disease? International Journal of Tuberculosis and Lung Disease. 2009 Mar;13(3):387-393.
Perez-Padilla, Rogelio ; Vollmer, W. M. ; Vázquez-García, J. C. ; Enright, P. L. ; Menezes, A. M B ; Buist, A (Sonia). / Can a normal peak expiratory flow exclude severe chronic obstructive pulmonary disease?. In: International Journal of Tuberculosis and Lung Disease. 2009 ; Vol. 13, No. 3. pp. 387-393.
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N2 - BACKGROUND: Chronic obstructive pulmonary disease (COPD) is underdiagnosed. One barrier to diagnosis is the limited availability of spirometry testing, but in adults at risk for COPD, a normal pre-bronchodilator (pre-BD) peak expiratory flow (PEF) may rule out clinically significant COPD. OBJECTIVE: To identify post-BD airway obstruction using data from 13 708 individuals aged ≥40 years from the PLATINO and BOLD studies. METHODS: We evaluated different cut-off points of pre-BD. The PEF was obtained from a diagnostic-quality spirometer (not a mechanical PEF meter). At least one of the following COPD risk factors was present in 77% of the subjects: chronic respiratory symptoms; exposure to tobacco smoke, biomass smoke or dust in the workplace; or a previous diagnosis of asthma, COPD, emphysema or chronic bronchitis. RESULTS: Although the positive predictive value was low as expected, a pre-BD PEF of ≥70% predicted effectively ruled out Stages III and IV COPD of the Global Initiative for Chronic Obstructive Lung Disease. Among those with at least one risk factor, only 12% would require confirmatory spirometry using this criterion. CONCLUSIONS: Adding PEF measurement to a screening questionnaire may rule out severe to very severe COPD without the need for pre- and post-BD spirometry testing. Confirmation is needed from a study using inexpensive PEF meters or pocket spirometers with a staged screening protocol.

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