Research article summary (published 30 Sep 2009):

[Diagnostic value of peak flow variability in patients with suspected diagnosis of bronchial asthma in general practice]

(Diagnostischer Wert der Peak-Flow-Variabilität bei Verdacht auf Asthma bronchiale in der Hausarztpraxis.)

Full Abstract

BACKGROUND: National guidelines advice self measurement of peak flow variability as a diagnostic tool for asthma. However, its actual value for this purpose remains controversial. PATIENTS AND METHODS: 219 persons were recruited by 14 general practitioners after they presented themselves for the first time with symptoms suspicious of obstructive airway disease. They were asked to measure and record peak expiratory flow (PEF) three times daily for two weeks. PEF variability was calculated with three different indices and compared to the post bronchodilator FEV (1) response or methacholine inhalation challenge. RESULTS: 132 (60.3 %) patients completed the peak flow diary. 60 (45.5 %) of them were found to have asthma. But the sensitivity, specificity and predictive values of PEF variability were low. The number of daily measurements did not enhance diagnostic accuracy. Variation of the cut-off value (PEF variability > 25 %) increased the probability for asthma to 77.8 %. However, only one out of six had PEF variability > 25 %. None of the three methods sufficed to rule out asthma. CONCLUSION: The diagnostic accuracy of PEF variability was low. Thus, in case of inconclusive spirometric results in general practice bronchial provocation remains an essential tool for diagnosing asthma. Diagnostic algorithms, as recommended by national guidelines, should be reconsidered in relation to the diagnostic value of peak flow variability. Copyright Georg Thieme Verlag KG Stuttgart . New York.

Author information

Author/s: Tilemann, L (L); Gindner, L (L); Meyer, F J (FJ); Laux, G (G); Szecsenyi, J (J); Schneider, A (A);

Affiliation: Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg.

Journal and publication information

Publication Type: English Abstract; Journal Article

Journal: Deutsche medizinische Wochenschrift (1946) (Dtsch Med Wochenschr), published in Germany. (Language: ger)

Reference: 2009-Oct; vol 134 (issue 41) : pp 2053-8

Dates: Created 2009/10/05; Completed 2009/10/09;

PMID: 19802765, status: MEDLINE (last retrieval date: 10/9/2009, IMS Date: )

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Albuterol - diagnostic use Asthma - diagnosis; physiopathology Bronchial Provocation Tests Bronchoconstrictor Agents - diagnostic use Bronchodilator Agents - diagnostic use Diagnosis, Differential Family Practice Humans Methacholine Chloride - diagnostic use

Methacholine Chloride - diagnostic use Peak Expiratory Flow Rate Plethysmography, Whole Body Predictive Value of Tests Pulmonary Disease, Chronic Obstructive - diagnosis; physiopathology ROC Curve Reference Standards Sensitivity and Specificity Spirometry

Associated Chemicals: Bronchoconstrictor Agents (0) ; Bronchodilator Agents (0) ; Albuterol (18559-94-9) ; Methacholine Chloride (62-51-1)

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