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. S. Buist

Research output: Contribution to journalArticle

39 Scopus citations

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 1 2009

Keywords

  • BOLD
  • COPD
  • PEF
  • PLATINO
  • Screening

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Infectious Diseases

Fingerprint Dive into the research topics of 'Can a normal peak expiratory flow exclude severe chronic obstructive pulmonary disease?'. Together they form a unique fingerprint.

  • 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.