Chest
Clinical Investigations: Hysiology: ArticlesIntraindividual Peak Flow Variability
Section snippets
Materials and Methods
The study population consisted of 301 healthy volunteers between ages 4 and 84 years (141 male, 160 female) recruited for a “normal values” study from three cities located near sea level (Atlanta, mean barometric pressure 740 mm Hg; Boston, mean barometric pressure 740 mm Hg; and Hartford, Conn, mean barometric pressure 760 mm Hg) and one located at an altitude of 1,400 m (Salt Lake City, Utah, mean barometric pressure 642 mm Hg). Recruited subjects were mostly hospital employees, their
Statistical Methods
The data were analyzed using statistical software packages (Abstat, Anderson-Bell Corp, Parker, Colo, and SPSS, SPSS Corp, Chicago). The average of the three highest PEF values for each subject was calculated (high three mean). Every PEF value for each subject was then divided by the high three mean and a histogram of all measurements was created and analyzed. Based on this analysis, outliers for each individual were identified as those values deviating from the high three mean by more than 20%
Intraindividual Variability
Three hundred one subjects were tested (141 male, 160 female). All were white. Eighty-one subjects were studied at 1,400 m altitude and 220 were studied near sea level. Sixty-nine subjects were younger than 21 years old, including 36 younger than 12 years old. There were 232 subjects aged 21 years or older, including 29 elderly subjects (age >64 years). Using all acceptable values, mean population PEF1 was 522.8 L/min, mean SD1 was 22.2 L/min (95% confidence interval [CI], 20.6 to 24.1), and
Discussion
This study was limited to a single model of peak flowmeter. However, reproducibility among several of the available brands of hand-held peak flowmeters has been shown to be less than ±5% at flow rates greater than 100 L/min.23 This study was also limited to normal subjects; variance in patients with obstructive lung disease has been reported to be 64% greater than in normal subjects21 and the percentage of change in PEF measured by spirometry required for significance in patients with
ACKNOWLEDGMENTS
We thank Mark Cassidy, Mt. Sinai Hospital, Hartford, Conn, Debbie Crews, LDS Hospital, Salt Lake City, Utah, Marilyn Helgesen, Emory University Hospital, Atlanta, and Domenic Misiano, Massachusetts General Hospital, Boston, for their technical support.
References (31)
- et al.
The role of the peak flow meter in the diagnosis and management of asthma
J Allergy Clin Immunol
(1991) - et al.
Significance of intraindividual changes in maximum expiratory flow volume and peak expiratory flow measurements
Chest
(1982) - et al.
Comparison of PERF and FEV1 in patients with varying degrees of airway obstruction: effect of modest altitude
Chest
(1989) - et al.
Spirometry, lung volumes and airway resistance in normal children aged 5 to 18 years
Br J Dis Chest
(1970) - et al.
Peak expiratory flow rate at high altitude [letter]
Lancet
(1983) - et al.
Lung volumes and forced ventilatory flows: official statement of the European Respiratory Society
Eur Respir J
(1993) - et al.
Dependence of maximal flow-volume curves on time course of preceding inspiration
J Appl Physiol
(1993) - et al.
Relation between FEV1 and peak expiratory flow in patients with chronic airflow obstruction
Thorax
(1988) - National Asthma Education Program (NAEP). Guidelines for the diagnosis and management of asthma. Bethesda, Md: National...
- et al.
Comparison of peak expiratory flow and FEV1 admission criteria for acute bronchial asthma
Ann Emerg Med
(1982)
Guidelines on the management of asthma
Thorax
Single and serial measurements of lung function in the diagnosis of occupational asthma
Eur J Respir Dis
Occupational asthma: validity of monitoring of peak expiratory flow rates and non-allergic bronchial responsiveness as compared to specific inhalation challenge
Eur Respir J
Bronchial responsiveness to histamine: relationship to diurnal variation of peak flow rate, improvement after bronchodilator, and airway calibre
Thorax
Comparison of bronchial reactivity and peak expiratory flow variability measurements for epidemiologic studies
Am Rev Respir Dis
Cited by (33)
Peak Flow and Voice Pathology
2009, Journal of VoiceCitation Excerpt :Peak flow readings in isolation are not representative of individual lung function. Expected values of peak flow were obtained from Hegewald et al.26 These Hegewald et al's values were used to obtain fraction of expected peak flow for each subject. The expected peak flow values, along with the resultant characteristics of peak flow fraction, are shown in Figure 2.
Inter-session reproducibility of peak expiratory flow with standardized expiratory maneuvers
2007, Respiratory MedicineCitation Excerpt :Our findings also expand upon previous studies by showing that standardization of forced expiratory maneuvers does not appreciably reduce the between-session reproducibility of PEF. Although calibration errors may account for a small portion of PEF variability,15 the greatest source of week-to-week variability in healthy volunteers appears to be related to biological variability. This refers to circadian changes in airway resistance, heightened non-specific airway hyper-responsiveness, or differences in parasympathetic tone.16
Peak expiratory flow with or without a brief postinspiratory pause
2005, ChestCitation Excerpt :The 95% limits of agreement, however, ranged from −0.9 to 1.0 L/s. This range of dispersion is relatively large and is most likely related to the intraindividual variability of PEF.7131415 In several previous studies, fast inspiratory maneuvers with no breathhold were associated with greater PEF values in healthy volunteers,237 as well as patients with asthma,716 COPD,5 cystic fibrosis,4 or restrictive diseases6 when compared with maneuvers that included a breathhold of about 4 to 6 s.
Occupational asthma in the cotton textile industry: Assessment by bronchial hyperreactivity and peak expiratory flow recording
2002, Revista Portuguesa de PneumologiaEvaluation of physician and patient compliance with the use of peak flow meters in commercial insurance and Oregon Health Plan asthmatic populations
2000, Annals of Allergy, Asthma and Immunology
Supported by a grant from Health Scan Inc, Cedar Grove, NJ. Manuscript received December 7, 1993; revision accepted May 17, 1994