COMPARISON BETWEEN PEAK EXPIRATORY FLOW-RATES (PEFR) AND FEV1 IN THE MONITORING OF ASTHMATIC SUBJECTS AT AN OUTPATIENT-CLINIC

Peak expiratory flow rate (PEFR) monitoring is often used alone in evaluating bronchial caliber and the response to a bronchodilator in the assessment of asthmatic subjects. A 15% change in airway caliber has been proposed as the criteria for modifying treatment. Our aim was to determine if changes in PEFR from one visit to the next can adequately evaluate changes in airway caliber as assessed by FEV(1), which is considered the gold standard, and to identify the characteristics of subjects whose evaluations were inadequate. This was a retrospective study of 197 asthmatic subjects seen regularly at an outpatient clinic for whom FEV(1) and PEFR assessments, prebronchodilator and postbronchodilator, were available for two visits. There was a high correlation between PEFR and FEV(1) (in absolute value or percent predicted) (r=0.83 and r=0.75). However, 24 of 56 (43%) of those who had a change in FEV(1) of 15% or more between two visits (mean change [%]+/-SD, range [best-lowest/best]=20.9+/-5.1%, 15 to 36%) showed changes in PEFR of less than 15% (6.7+/-6.5%, 8.0 to 13.9%). On the other hand, 14 of 42 (33%) subjects with changes in FEV(1) of less than 15% (9.8+/-3.2%, 1.1 to 13.8%) had changes in PEFR of 15% or more (22.2+/-10.9%, 16 to 35%). This discrepancy was not related to differences in baseline FEV(1), control status, or the relationship between changes in FEV(1) and PEFR in response to a bronchodilator. In conclusion, assessment of airway caliber through PEFR monitoring may not be valid in some asthmatic subjects and can often lead to underestimation or overestimation of changes in FEV(1). None of the explanations considered made it possible to identify these subjects.