ArticleThorax1999
Can peak expiratory flow measurements reliably identify the presence of airway obstruction and bronchodilator response as assessed by FEV(1) in primary care patients presenting with a persistent cough?
Article in Thorax, 1999. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03864354 (The Immediate, Intermediate, and Long-Term Effects of Osteopathic Manipulative Treatment on Pulmonary Function in Adults With Asthma), which is not on this map. Cited by 12 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
The Immediate, Intermediate, and Long-Term Effects of Osteopathic Manipulative Treatment on Pulmonary Function in Adults With Asthma
Who cites it
12 citing papers in PubMed, 1 synthesis or guideline pooled it, 76 citations in OpenAlex.
- Guideline
- Relation of changes in PEF and FEVEuropean clinical respiratory journal · 2026Article
- Relation of Changes in PEF and FEVPulmonary medicine · 2025Article
- A Novel Case-Finding Instrument for Chronic Obstructive Pulmonary Disease in Low- and Middle-Income Country Settings.International journal of chronic obstructive pulmonary disease · 2020Article
- An accurate prediction model to identify undiagnosed at-risk patients with COPD: a cross-sectional case-finding study.NPJ primary care respiratory medicine · 2019Article
- Diurnal Variation in Peak Expiratory Flow and Forced Expiratory Volume.Journal of clinical and diagnostic research : JCDR · 2015Article
- Peak expiratory flow rate as a surrogate for forced expiratory volume in 1 second in COPD severity classification in Thailand.International journal of chronic obstructive pulmonary disease · 2015Article
- Peak expiratory flow as a surrogate for health related quality of life in chronic obstructive pulmonary disease: a preliminary cross sectional study.Ghana medical journal · 2014Article
- Logistic regression model for prediction of airway reversibility using peak expiratory flow.Tanaffos · 2012Article
- Personal and ambient air pollution exposures and lung function decrements in children with asthma.Environmental health perspectives · 2008Article
- Best Treatment Guidelines For Bronchial Asthma.Medical journal, Armed Forces India · 2007Article
- Review
Corrections and comments
- Commented on by
- Commented on byPEF versus FEV1.2000
Authors and funding
7 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIn general practice airway obstruction and the bronchodilator response are usually assessed using peak expiratory flow (PEF) measurements. A study was carried out in patients presenting with persistent cough to investigate to what extent PEF measurements are reliable when compared with tests using forced expiratory volume in one second (FEV(1)) as the measure of response.
methodsData (questionnaire, physical examination, spirometry, PEF) were collected from 240 patients aged 18-75 years, not previously diagnosed with asthma or chronic obstructive pulmonary disease (COPD), who consulted their general practitioner with cough of at least two weeks duration. The relationship between low PEF (PEF < PEFpred - 1.64RSD) and low FEV(1) (FEV(1) < FEV(1)pred - 1.64RSD) was tested. A positive bronchodilator response after inhaling 400 microg salbutamol was defined as an increase in FEV(1) of > or = 9% predicted and was compared with an absolute increase in PEF with cut off values of 40, 60, and 80 l/min and DeltaPEF % baseline with cut off values of 10%, 15%, and 20%.
resultsForty eight patients (20%) had low FEV(1), 86 (35.8%) had low PEF, and 32 (13.3%) had a positive bronchodilator response. Low PEF had a positive predictive value (PPV) for low FEV(1) of 46.5% and a negative predictive value (NPV) of 95%. DeltaPEF of > or = 10%, > or = 15%, or > or = 20% baseline had PPVs of 36%, 52%, and 67%, respectively, and DeltaPEF of > or = 40, > or = 60, and > or = 80 l/min in absolute terms had PPVs of 39%, 45%, and 57%, respectively, for DeltaFEV(1) > or = 9% predicted; NPVs were high (88-93%).
conclusionsAlthough PEF measurements can reliably exclude airway obstruction and bronchodilator response, they are not suitable for use in the assessment of the bronchodilator response in the diagnostic work up of primary care patients with persistent cough. The clinical value of PEF measurements in the diagnosis of reversible obstructive airway disease should therefore be re-evaluated.
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