Inaccuracy of “Personal Best” Peak Expiratory Flow Rate Reported by Inner-City Patients with Acute Asthma

Diner, Barry; Brenner, Barry E.; Camargo, Carlos A.

doi:10.1081/jas-100000030

Cited by 16 publications

(6 citation statements)

References 6 publications

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“…3 However, the need to standardise the assessment and recording of personal best PEF has been highlighted by a study of 104 patients presenting with acute asthma. 8 At presentation, only 30 patients knew their personal best PEF and, of these, 10/22 recorded a higher PEF over the next 24 days.…”

Section: Discussionmentioning

confidence: 99%

When can personal best peak flow be determined for asthma action plans?

Reddel

Marks²,

Jenkins³

2004

Thorax

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Background: Written asthma action plans based on personal best peak expiratory flow (PEF) consistently improve health outcomes, whereas those based on predicted PEF do not. Guidelines state that personal best PEF should be assessed over 2-3 weeks during good asthma control, but it is unclear how long to wait after commencing or changing treatment. Methods: Electronically recorded spirometric data from 61 subjects with initially poorly controlled asthma from a 72 week budesonide study were analysed. For each week, average morning pre-bronchodilator PEF was calculated and personal best PEF was determined as the highest PEF in the previous 2 weeks. The time to plateau was defined as the week beyond which no further improvement occurred. Results: At baseline, average morning PEF was 61% predicted and personal best PEF was 87% predicted. Personal best PEF from twice daily monitoring increased to a plateau of 95% predicted (p,0.0001) after only 3 weeks of budesonide treatment. However, average morning PEF continued to improve for 3 months and ''as needed'' reliever use for 7 months. Conclusions: Personal best PEF is a useful concept for asthma self-management plans when determined as the highest PEF over the previous 2 weeks. With twice daily monitoring, personal best PEF reaches plateau levels after only a few weeks of corticosteroid treatment.

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Section: Discussionmentioning

confidence: 99%

When can personal best peak flow be determined for asthma action plans?

Reddel

Marks²,

Jenkins³

2004

Thorax

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“…Ma sebbene il PEF possa essere prezioso nel trattamento domiciliare dell'asma, vi sono considerevoli controversie riguardo alla sua utilità in Pronto Soccorso. Numerosi studi, tra cui un ampio trial, hanno dimostrato come il PEF non abbia valore prognostico né decisionale perché non correla con la necessità di ricovero o con la probabilità di ritorno in Pronto Soccorso per recidiva precoce [25][26][27][28] . Inoltre in fase acuta la sua misurazione risulta difficile per il paziente, specie se non abituato a utilizzare lo strumento a domicilio.…”

Section: Il Mio Paziente Ha Un Attacco D'asma? Quanto è Grave?unclassified

Acute bronchial asthma

et al. 2007

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Materiale protetto da copyright. Non fotocopiare o distribuire elettronicamente senza l'autorizzazione scritta dell'editore. Il caso clinicoUna donna di 56 anni giunge in Pronto Soccorso verso l'una del mattino per dispnea ingravescente dal giorno prima. Nega sindrome da raffreddamento. È nota per asma allergico con 6 accessi in PS nel corso dell'anno precedente e un ricovero per crisi asmatica alcuni anni prima. In anamnesi risultano anche ipertensione arteriosa e sindrome ansioso-depressiva. La terapia cronica comprende paroxetina, lercanidipina e salmeterolo/fluticasone 25/250 µg. All'esame obiettivo la paziente appare lucida, apiretica, tachi-dispnoica, con decubito ortopnoico obbligato e utilizzo della muscolatura accessoria. All'auscultazione toracica, il murmure vescicolare è ridotto su tutto l'ambito, con broncospasmo diffuso e normofonesi plessica. Si rilevano i seguenti parametri: pressione arteriosa 190/95; frequenza cardiaca 120 r; frequenza respiratoria 36 atti/min; SaO 2 84% in aria ambiente. Sono pertanto somministrati:• O 2 6 l/min con reservoir (FiO 2 50% circa), ottenendo un'ossimetria pari a 97%; • metilprednisolone 80 mg ev (circa 1 mg/kg); • aerosol con salbutamolo e ossitropio bromuro. Si richiedono intanto gli esami ematochimici di base e l'emogasanalisi. Entro un'ora si assiste al netto miglioramento della sintomatologia, con scomparsa del broncospasmo e SaO 2 in aria del 96%. Le indagini mostrano: globuli bianchi 13.000/ml; PCR 0,6 mg/dl; PaO 2 90 mmHg, PaCO 2 45 mmHg, in O 2 6 l/min con reservoir. La paziente è trattenuta in osservazione. A due ore dall'ingresso in PS, compaiono nuovamente modica dispnea a riposo, desaturazione in aria (SaO 2 90%) e broncospasmo. Si somministrano ancora ossigeno 4 l/min con occhialini nasali (FiO 2 28% circa) e salbutamolo + ossitropio bromuro per via inalatoria con distanziatore ripetuto una seconda volta dopo 30 minuti, ottenendo un miglioramento più stabile del quadro clinico. Viene richiesta una radiografia del torace, che evidenzia una stria disventilativa alla base destra e un lieve rinforzo del disegno polmonare ilo-perilare e bibasilare. Alle 6 del mattino la paziente viene ricoverata in reparto di Medicina generale da dove viene dimessa 3 giorni dopo. Tra gli accertamenti eseguiti in reparto segnaliamo: IgE totali elevate (130); prove di funzionalità respiratoria alla dimissione compatibili con probabile ostruzione di medio grado delle vie aeree (FEV 1 80% del predetto, PEF 28%). Il basso livello di PEF, incompatibile con il netto miglioramento del quadro clinico, documenta l'occasionale difficoltà nell'eseguire le manovre di valutazione della funzione polmonare. In dimissione viene prescritto un ciclo di 7 giorni di terapia corticosteroidea per via orale e viene rivalutata la tecnica di utilizzo degli inalatori. Viene inoltre previsto un controllo ambulatoriale a breve termine. L'asma acuto bronchiale

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“…10 A simple but important test is to measure the maximal airflow rate achieved while forcefully expelling air from the lungs, following maximal inspiration. 11 This is called PEFR. Narrowing of the airways reduces the ability to move air in and out of the lungs.…”

Section: Introductionmentioning

confidence: 99%

“…[15][16][17] PEFR measures the maximal airflow rate achieved while forcefully expelling air from the lungs, following maximal inspiration. 11 Earlier detection of airflow obstruction and smoking cessation may result in substantial health gain. 18 If a person quits smoking, PEFR improves with the passage of time.…”

Section: Introductionmentioning

confidence: 99%

Study of peak expiratory flow rate in young smokers in community

Mehta¹,

Satani²

2022

Int J Community Med Public Health

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Background: Inhaling of cigarette smoke has sudden effect on airways which causes an inflammation in the peripheral airways. Pulmonary function testing (PFT) provides a quantitative and objective assessment of the physiological derangement associated with pulmonary diseases. A study of PEFR in smokers and non-smokers would provide the necessary data to correlate smoking and the effect on the pulmonary health of smokers. Objectives were to study the effect of smoking on lung functions in apparently healthy young smokers and to measure the PEFR and compare the values between young smokers and non-smokers in the villages surrounding Vadodara District, Gujarat.Methods: It was a cross-sectional comparative study. With convenient sampling of total 60 male subjects which are equally divided into smokers (group A) and non-smokers (group B) group between the ages 17-25 years. The PEFR was measured by Wright’s Mini PulmoPeak Flow Meter. Three readings were taken and best of three was documented. Comparison of PEFR values between smokers and non-smokers was done.Results: The mean PEFR between smokers and non-smokers was group A is 310.00 and group B was 440.00 litres/minute (p value <0.05) and the t value was 7.608 which shows that the PEFR of smokers is significantly lower than non-smokers.Conclusions: The values of PEFR are reduced in smokers compared to non-smokers in young individuals in community and all the values are more decreased with increase in number of cigarettes smoke per day.

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Inaccuracy of “Personal Best” Peak Expiratory Flow Rate Reported by Inner-City Patients with Acute Asthma

Cited by 16 publications

References 6 publications

When can personal best peak flow be determined for asthma action plans?

When can personal best peak flow be determined for asthma action plans?

Acute bronchial asthma

Study of peak expiratory flow rate in young smokers in community

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