Chest
Volume 131, Issue 5, May 2007, Pages 1494-1499
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Original Research: Pulmonary Function Testing
Peak Expiratory Flow Is Not a Quality Indicator for Spirometry: Peak Expiratory Flow Variability and FEV1 Are Poorly Correlated in an Elderly Population

https://doi.org/10.1378/chest.06-2707Get rights and content

Background

Peak forced expiratory flow (PEF) and FEV1 are spirometry measures used in diagnosing and monitoring lung diseases. We tested the premise that within-test variability in PEF is associated with corresponding variability in FEV1 during a single test session.

Methods

A total of 2,464 healthy adults from the Health, Aging, and Body Composition Study whose spirometry results met American Thoracic Society acceptability criteria were screened and analyzed. The three “best” test results (highest sum of FVC and FEV1) were selected for each subject. For those with acceptable spirometry results, two groups were created: group 1, normal FEV1/FVC ratio; group 2, reduced FEV1/FVC ratio. For each subject, the difference between the highest and lowest PEF (ΔPEF) and the associated difference between the highest and lowest FEV1 (ΔFEV1) were calculated. Regression analysis was performed using the largest PEF and best FEV1, and the percentage of ΔPEF (%ΔPEF) and percentage of ΔFEV1 (%ΔFEV1) were calculated in both groups.

Results

Regression analysis for group 1 and group 2 showed an insignificant association between %ΔPEF and %ΔFEV1 (r2 = 0.0001, p = 0.59, and r2 = 0.040, p = 0.15, respectively). For both groups, a 29% ΔPEF was associated with a 1% ΔFEV1.

Conclusion

Within a single spirometry test session, %ΔPEF and %ΔFEV1 contain independent information. PEF has a higher degree of intrinsic variability than FEV1. Changes in PEF do not have a significant effect on FEV1. Spirometry maneuvers should not be excluded based on peak flow variability.

Section snippets

Materials and Methods

Participants from the Health, Aging, and Body Composition Study were analyzed. All participants were 70 to 79 years old during recruitment, free of disability in activities of daily living, and free of functional limitations. The institutional review boards at both field centers approved the study, and informed consent was obtained. Subjects performed spirometry and were coached to perform maximal efforts. A National Institute for Occupational Safety and Health volume-based spirometer using a

Results

Of the 3,075 participants in the Health, Aging, and Body Composition Study, 2,863 subjects performed the spirometric evaluation; 352 subjects were excluded because they did not meet ATS acceptability and reproducibility criteria (12.3% of total). Forty-seven subjects were excluded based on a 50% ΔPEF (1.9% of total). Data from 2,464 subjects were analyzed. The mean age of participants was 73.6 ± 2.86 years (± SD). Gender distribution was 49% male and 51% female. Fifty-nine percent of the

Discussion

Our study demonstrates that in healthy older subjects within a single test session, there is a poor correlation between PEF variability and FEV1 variability. An average 29% ΔPEF has an associated average ΔFEV1 of 1%. FEV1 is a stable measurement even with large changes in PEF. This suggests that FEV1 and PEF measure different aspects of lung function. This is not unexpected because PEF occurs in the first 100 to 200 ms of an expiratory effort and is considered a measure of large airway

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    This study was supported by contracts N01-AG-6–2101, N01-AG-6–2103, and N01-AG-6–2106, and was also supported in part by the Intramural Research program of the National Institutes of Health, National Institute on Aging.

    The authors have no conflicts of interest to disclose.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

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