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Background Methods Results Conclusions Poor respiratory function, including low peak expiratory flow (PEF), is a risk factor for dementia. Motoric cognitive risk syndrome (MCR) is a predementia syndrome characterized by slow gait and subjective cognitive complaints. However, the association between PEF and MCR remains unclear. This study examined the cross‐sectional and longitudinal association between PEF and MCR.The National Health and Aging Trends Study (NHATS), which is a nationally representative cohort of adults ≥65 years of age in the United States, was analyzed from 2011 to 2017. Logistic regression and discrete‐time proportional hazards models tested the association of PEF standardized residuals (SR) at baseline with prevalent and incident MCR, respectively. The models adjusted for multiple sociodemographic and health‐related covariates.Among 5328 participants (57% women) included at baseline, lower PEF SR was associated with higher prevalence of MCR. Compared with the ≥80 PEF SR percentile group, the <30 and 30–50 percentile groups had significantly higher odds of prevalent MCR (OR 3.04 [95% CI 1.85, 5.01]; OR 2.06 [95% CI 1.19, 3.54], respectively). Over six years of follow‐up, lower PEF SR was also associated with higher incidence of MCR. Compared with the ≥80 PEF SR percentile group, the <30 and 30–50 percentile groups had significantly higher risk of incident MCR (HR 1.81 [95% CI 1.24, 2.66]; HR 1.55 [95% CI 1.02, 2.34], respectively).Lower PEF was associated with higher prevalence and incidence of MCR. Poor respiratory function should be further investigated as a potentially modifiable risk factor for MCR and cognitive decline. [ABSTRACT FROM AUTHOR]

BACKGROUND: We investigated the association of peak expiratory flow (PEF) with dementia; cognitive impairment, no dementia (CIND); and transition from CIND to dementia, and possible underlying neuropathological mechanisms. METHODS: A population‐based cohort of adults aged 60+ was followed over 15 years to detect dementia (Diagnostic and Statistical Manual of Mental Disorders, 4th edition criteria), CIND (assessed through a cognitive battery), and progression from CIND to dementia, in relation to baseline PEF observations. A subsample (n = 462) had 6‐year follow‐up data on brain magnetic resonance imaging markers of neurodegeneration and small vessel disease. RESULTS: In fully adjusted models, poor PEF performance (< 10th vs. ≥ 80th percentile) was associated with increased hazards for dementia (hazard ratio [HR] = 1.89; 95% confidence interval [CI] = 1.23–2.92) and CIND (HR = 1.55; 95% CI = 1.01–2.38) and CIND progression to dementia, although not statistically significantly (HR = 2.44; 95% CI = 0.78–6.88). People with poor PEF also experienced the fastest ventricular enlargement (β coefficient = 0.67 mL/year; 95% CI = 0.13–1.21) and had the highest likelihood of developing lacunes (odds ratio = 5.05; 95% CI = 1.01–25.23). DISCUSSION: Poor lung function contributes to cognitive deterioration possibly through accelerated brain atrophy and microvascular damage. Highlights: Poor lung function increased the risk of dementia and mild cognitive impairment (MCI).Poor lung function accelerated the progression from MCI to dementia.Poor lung function was linked to brain microvascular damage and global brain atrophy. [ABSTRACT FROM AUTHOR]

Objectives: Serial intralesional steroid injection (SILSI) has been increasingly used to treat idiopathic subglottic stenosis (iSGS). Prior studies have shown effectiveness, but not in all patients. This multi‐institutional study evaluates the effect of SILSI on time to recurrent operation, peak expiratory flow (PEF), and dyspnea. Methods: Post‐hoc secondary analysis of the North American Airway Collaborative data were performed to evaluate the outcomes of iSGS patients undergoing and not undergoing SILSI. The primary outcome was time to recurrent operation, evaluated using Kaplan–Meier curves and Cox regression analysis. Secondary outcomes were change in PEF and clinical chronic obstructive pulmonary disease questionnaire (CCQ) score. Within patients undergoing SILSI, demographics, time from last procedure, and PEF at initiation of SILSI were evaluated to determine the effect on recurrence. Results: Two hundred and ninety patients were included, 238 undergoing endoscopic dilation alone and 52 undergoing dilation and SILSI. No differences in baseline characteristics were observed. There was no difference in time to recurrence (hazard ratio: 0.64; p = 0.183). There were no differences in PEF or CCQ across the 2.5‐year study period. Among 52 patients undergoing SILSI, PEF at the time of starting SILSI did not affect recurrence (χ2 = 0.09, p = 0.77). Conclusion: Patients undergoing and not undergoing SILSI had similar times to recurrence, PEF, and CCQ. Factors predicting recurrence among patients undergoing SILSI were not identified. These results support a randomized controlled trial with a uniform SILSI protocol to quantify the effects of SILSI on objective and subjective outcomes and help determine which iSGS patients benefit most. Level of Evidence: 3 Laryngoscope, 133:2255–2263, 2023 [ABSTRACT FROM AUTHOR]

Objective: The aim was to examine the correlations among the anatomic Cotton-Myer classification, pulmonary function tests (PFTs), and patient-perceived dyspnea or dysphonia in patients with subglottic stenosis and identify measurements accurately reflecting treatment effects.Study Design: Prospective cohort study.Setting: Tertiary referral center.Method: Fifty-two adults receiving endoscopic treatment for isolated subglottic stenosis were consecutively included. Correlations were calculated among the preoperative Cotton-Myer scale, PFTs, the Dyspnea Index (DI), and the Voice Handicap Index. Receiver operating characteristic curves were determined for PFT, DI, and Voice Handicap Index pre- and postoperative measurements.Results: The Cotton-Myer classification correlated weakly with peak expiratory flow (r = -0.35, P = .012), expiratory disproportion index (r = 0.32, P = .022), peak inspiratory flow (r = -0.32, P = .022), and total peak flow (r = -0.36, P = .01). The DI showed an excellent area under the curve (0.99, P < .001), and among PFTs, the expiratory disproportion index demonstrated the best area under the curve (0.89, P < .001), followed by total peak flow (0.88, P < .001), peak expiratory flow (0.87, P < .001), and peak inspiratory flow (0.84, P < .001). Patients treated endoscopically with balloon dilatation showed a 53% decrease in expiratory disproportion index (95% CI, 41%-66%; P < .001) and a 37% improvement in peak expiratory flow (95% CI, 31%-43%; P < .001).Conclusion: Expiratory disproportion index or peak expiratory flow combined with DI was a feasible measurement for the monitoring of adult subglottic stenosis. The percentage deterioration of peak expiratory flow and increase in expiratory disproportion index correlated significantly with a proportional percentage increase in DI. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: We sought to establish normative peak expiratory flow (PEF) data for patients with idiopathic subglottic stenosis (iSGS), evaluate whether immediate changes in PEF after a procedure predict long‐term treatment response, and test if a decline in longitudinal PEF is associated with disease recurrence. Study Design: International, prospective, 3‐year multicenter cohort study of 810 patients with untreated, newly diagnosed, or previously treated iSGS. Methods: iSGS patients consented and enrolled in the North American Airway Collaborative (NoAAC) iSGS1000 cohort recorded PEF data on a mobile smartphone app. Cox regression tested the associations between the magnitude of postoperative PEF improvement and longitudinal 90‐day PEF decline with the risk of disease recurrence. Results: Within the NoAAC iSGS1000 cohort, 810 patients participated in a 3‐year prospective study comparing surgical treatment efficacy and 385 had appropriate PEF measurements and follow‐up data. Of those patients, 42% (161/385) required at least one operation during study follow‐up. The mean PEF preceding operative intervention was 241 L/min (95% confidence interval [CI]: 120–380) corresponding to a predicted PEF of 52%. The mean increase in PEF following a procedure was 111 L/min (95% CI: 96–125 L/min). Interestingly, the magnitude of immediate PEF improvement was not predictive of disease recurrence (hazard ratio [HR] for 100 L/min increase = 0.90, 95% CI: 0.60–1.00). However, recurrence was associated with the magnitude of PEF decline over 90 days (30% vs. 10% decline, HR = 2.2, 95% CI: 1.5–3.0). Conclusions: We provide normative PEF data on a large iSGS patient cohort. The degree of PEF improvement immediately after surgery was not associated with a longer procedure‐free interval. However, a 30% decline in PEF over 90 days was associated with elevated risk of disease recurrence. Level of Evidence: 2 Laryngoscope, 131:E2841–E2848, 2021 [ABSTRACT FROM AUTHOR]

Background: The restrictions imposed by the COVID‐19 pandemic impact heavily the management of chronic diseases like asthma. This study aimed to evaluate the management of adults and children with asthma during COVID‐19‐related lockdown. Methods: A survey was launched by the European Academy of Allergy and Clinical Immunology (EAACI) via e‐mail, website, and social media to EAACI members and members of peer societies. Results: The survey was completed by 339 healthcare professionals from 52 countries. 79% of follow‐up consultations were replaced by phone calls, whereas 49% of newly referred patients attended the clinic. 62%, 76%, 66%, 76%, and 87% of responders did not conduct spirometry, impulse oscillometry, bronchodilator test, FeNO, or methacholine provocation, respectively, for asthma diagnosis in adults. The numbers were similar for children. 73% of responders based the initial asthma diagnosis and the prescription of inhaled therapy on clinical parameters only. Lung function tests were used in 29% of cases to monitor asthma worsening, and only 56% of participants were recommended to their patients ambulatory peak expiratory flow (PEF) measurements. Using a 1 (not at all) to 5 (very much) scale, the responders considered that the quality of healthcare provided and the patients' asthma status had deteriorated during the lockdown with 3.2 points and 2.8 points, respectively. Conclusion: Collectively, these results suggest that all necessary resources should be allocated to ensure the performance of lung function tests for initial diagnosis, whereas digital remote monitoring should be reinforced for the follow‐up of children and adults with asthma. [ABSTRACT FROM AUTHOR]

ABSTRACT Background and objective People with asthma may seek advice about physical activity. However, the benefits of leisure time physical activity on lung function are unclear. We investigated the association between leisure time physical activity and lung function decline in adults with asthma. Methods In a population-based cohort study in Norway, we used multiple linear regressions to estimate the annual mean decline in lung function (and 95% CI) in 1329 people with asthma over a mean follow-up of 11.6 years. The durations of light and hard physical activity per week in the last year were collected by questionnaire. Inactive participants did not report any light or hard activity, while active participants reported light or hard activity. Results The mean decline in forced expiratory volume in 1 s ( FEV1 ) was 37 mL/year among inactive participants and 32 mL/year in active participants (difference: −5 mL/year (95% CI: −13 to 3)). The mean decline in forced vital capacity ( FVC) was 33 mL/year among inactive participants and 31 mL/year in active participants (difference: −2 mL/year (95% CI: −11 to 7)). The mean decline in FEV1 / FVC ratio was 0.36%/year among inactive participants and 0.22%/year in active participants (difference: −0.14%/year (95% CI: −0.27 to −0.01)). The mean decline in peak expiratory flow ( PEF) was 14 mL/year among the inactive participants and 10 mL/year in active participants (difference: −4 mL/year (95% CI: −9 to 1)). Conclusion We observed slightly less decline in lung function in physically active than inactive participants with asthma, particularly for FEV1, FEV1/ FVC ratio and PEF. [ABSTRACT FROM AUTHOR]

Objective measures can be used to assist the clinician to diagnose and treat nasal obstruction and also to quantify nasal obstruction in research. Objective measurements of nasal obstruction are as important as objective measurements of lung function. peak nasal inspiratory flow ( PNIF), acoustic rhinometry ( AR) and rhinomanometry ( RM), with their specific peculiarity, assess different aspects of nasal obstruction. From the studies available in the literature, it seems that these methods roughly correlate with each other and that all of them can be alternatively utilized very well in research as well as in clinical practice. This review describes the various methods that can be used to measure nasal patency, airflow and resistance, mainly peak nasal inspiratory flow, rhinomanometry and acoustic rhinometry. PNIF has been demonstrated to be reproducible and as good an indication of objective nasal patency as formal rhinomanometry and has the advantage to be cheap, simple and suitable for serial measurements and for home use even in the paediatric population. PNIF normative data are available for children, adults and elderly subjects, and the availability of unilateral PNIF normal values allows evaluation of nasal sides separately. Just as in the lower airways, objective and subjective evaluation gives different information that together optimizes the diagnosis and the treatment of our patients. We argue that PNIF should be used regularly in every outpatient clinic that treats patients with nasal obstruction. [ABSTRACT FROM AUTHOR]

Background In the last 20 years, there has been an increase in the incidence of allergic respiratory diseases worldwide and exposure to air pollution has been discussed as one of the factors associated with this increase. The objective of this study was to investigate the effects of air pollution on peak expiratory flow (PEF) and FEV1 in children with and without allergic sensitization. Methods Ninety-six children were followed from April to July, 2004 with spirometry measurements. They were tested for allergic sensitization (IgE, skin prick test, eosinophilia) and asked about allergic symptoms. Air pollution, temperature, and relative humidity data were available. Results Decrements in PEF were observed with previous 24-hr average exposure to air pollution, as well as with 3-10-day average exposure and were associated mainly with PM10, NO2, and O3 in all three categories of allergic sensitization. Even though allergic sensitized children tended to present larger decrements in the PEF measurements they were not statistically different from the non-allergic sensitized. Decrements in FEV1 were observed mainly with previous 24-hr average exposure and 3-day moving average. Conclusions Decrements in PEF associated with air pollution were observed in children independent from their allergic sensitization status. Their daily exposure to air pollution can be responsible for a chronic inflammatory process that might impair their lung growth and later their lung function in adulthood. Am. J. Ind. Med. 55:1087-1098, 2012. © 2012 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To determine whether peak expiratory flow (PEF), when expressed by a validated method using standardized residual (SR) percentile, is associated with subsequent disability and death in older persons. DESIGN: Prospective cohort study. SETTING: New Haven, Connecticut. PARTICIPANTS: Seven hundred fifty-four initially nondisabled, community-living persons aged 70 and older. MEASUREMENTS: PEF was assessed at baseline along with chronic conditions and smoking history. The onset of persistent disability in activities of daily living (ADLs), continuous mobility disability, and death were ascertained during monthly interviews over a 5-year period. RESULTS: Participants' mean age was 78.4, 63.7% had a smoking history, and 17.4% reported chronic lung disease. The incidence rates per 100 person-months were 1.00 (95% confidence interval (CI)=0.90–1.12) for ADL disability, 0.80 (95% CI=0.70–0.93) for mobility disability, and 0.44 (95% CI=0.38–0.51) for death. At a PEF less than 10th SR percentile, identifying nearly one-quarter of the cohort, hazard ratios (HRs) adjusted for multiple confounders, including age, smoking, and chronic lung disease, demonstrated a greater risk of ADL disability (HR=1.79, 95% CI=1.23–2.62), mobility disability (HR=1.89, 95% CI=1.15–3.10), and death (HR=2.31, 95% CI=1.29–4.12). CONCLUSION: In an elderly cohort, it was found that low PEF, when expressed as an SR percentile, is independently associated with subsequent disability and death. These results support the use of PEF as a potentially valuable risk assessment tool in community-living older persons. [ABSTRACT FROM AUTHOR]

Patient education is a vital tool for managing patients with acute bronchospasm arising from both asthma and chronic obstructive pulmonary disease (COPD). Both are serious chronic diseases, and lack of patient education usually results in lack of patients' adherence to their therapies. Several surveys indicate that a tremendous disparity exists between physicians and patients with asthma in how they perceive control of the patient's lung disease. A high proportion of physicians report that they provide patient education, and a low proportion of patients claim to have received adequate education. Management plans for both asthma and COPD are outlined, including instructions for the use of peak-flow meters and profiles of inhalation devices. Although inhalation devices will continue to be the most common delivery systems for airway diseases that cause acute bronchospasm, their proper use can be both complex and diverse. Patient education, therefore, is essential for optimal benefit from therapy. [ABSTRACT FROM AUTHOR]

Background: The Clinical Outcomes with Montelukast as a Partner Agent to Corticosteroid Therapy (COMPACT) trial demonstrated that montelukast added to budesonide (MNT + BD) was as efficacious as double the dose of budesonide (dBD) in improving morning peak expiratory flow (AM PEF) in adult asthmatics. Recent studies have demonstrated that montelukast is also effective in treating daytime and nighttime allergic rhinitis (AR) symptoms in asthmatic patients. This analysis was designed to examine whether asthmatic patients with comorbid AR respond differently than patients without comorbid AR in terms of asthma control (lung function). Methods: There were 216 asthmatic patients in the MNT + BD group and 184 patients in the dBD group with AR. Treatment differences in the change from baseline in AM PEF were compared. Least square (LS) mean and 95% confidence interval (CI) were derived from ananova model adjusting for baseline and study site. Results: There was a 9.2% increase in AM PEF from baseline in the MNT + BD group compared with a 6% increase in the dBD group. The LS mean difference [(MNT + BD) − dBD] was 14.2 l/min ( P = 0.028). Other secondary endpoints were similar between groups. Conclusion: In the subgroup of asthmatic patients with AR, a combined treatment approach that included montelukast and budesonide provided significantly greater efficacy in reducing airflow obstruction compared with doubling the dose of budesonide. These results support recommendations by the Allergic Rhinitis and its Impact on Asthma initiative that suggest a unified approach aimed at treating the airway inflammation common to both diseases is beneficial for the large proportion of asthmatics who also suffer from AR. [ABSTRACT FROM AUTHOR]

Background Pregnancy frequently interferes with the course of bronchial asthma, and asthmatic pregnant women experience less successful pregnancies. T lymphocytes synthesizing IL-4 or IFN-γ are important in allergic mechanisms of the airways as well as in materno-fetal immunity. Objective We hypothesized that pregnancy (a T helper-2 polarized state) of asthmatics will enhance the number of circulating T2 lymphocytes, but decrease the subset-producing IFN-γ (T1 lymphocytes) and thereby cause a culminating T2 dominance with possible clinical consequences. Methods IL-4- or IFN-γ-producing T lymphocytes were determined by flow cytometry in healthy ( n=8) and asthmatic ( n=13) non-pregnant women and healthy ( n=18) and asthmatic ( n=48) pregnant women of similar chronological and gestational (2nd–3rd trimester) age and asthma severity (Global Initiative for Asthma II–III). Results In the blood of non-pregnant women – healthy or asthmatic – the numbers of IL-4- and IFN-γ+ T cells were very low (<10/μL blood). In contrast, in asthmatic pregnant women, the cell counts were 182±27 and 39±6 for IFN-γ+ and IL-4+ T cells/μL blood, respectively (both P<0.05 vs. respective control values of non-pregnant asthmatics). Within the asthmatic pregnant group, significant negative correlations were revealed between the numbers of IFN-γ+ or IL-4+ T cells and maternal peak expiratory flow as well as birth weight of newborns (both P<0.05). Conclusion These data show a previously unknown immunological interference between asthma and pregnancy. The culminating proliferation of IFN-γ+ and IL-4+ T lymphocytes may potentially impair maternal airway symptoms as well as fetal development. [ABSTRACT FROM AUTHOR]

A randomised, open-label, multicentre study compared the efficacy and tolerability of salmeterol 25 µg/fluticasone propionate 125 µg (two puffs, twice daily) delivered via a hydrofluoroalkane metered-dose inhaler (HFA-MDI) and salmeterol 50µg/fluticasone propionate 250 µg (one puff, twice daily) delivered via a Diskus™ inhaler in Chinese patients with moderate asthma uncontrolled with inhaled corticosteroids (ICSs). Morning peak expiratory flow (PEF) was the primary efficacy endpoint. Secondary endpoints included evening PEF, forced expiratory volume in 1 s, day and night symptom scores, rescue medication and patient self-evaluation of efficacy. Safety was assessed according to adverse events recorded. Both treatments were equipotent and significantly improved morning PEF (HFA-MDI 40 l/min; Diskus™ 42 l/min; p < 0.05) and all secondary endpoints (p < 0.05) from baseline, over 1–4 weeks. Similarly, both treatments were well tolerated. Salmeterol/fluticasone propionate delivered via an HFA-MDI or Diskus™ inhaler provides a choice of efficacious delivery systems in Chinese patients whose asthma is poorly controlled on ICSs alone. [ABSTRACT FROM AUTHOR]

Hung C-H, Li C-Y, Lai Y-S, Hsu P-C, Hua Y-M, Yang KD. Discrepant clinical responses and blood chemokine profiles between two non-steroidal anti-inflammatory medications for children with mild persistent asthma.Pediatr Allergy Immunol 2005:16: 306–309.© 2005 Blackwell MunksgaardIn a randomized study, two oral medications, ketotifen and montelukast, were compared for children with mild persistent asthma. Montelukast revealed faster clinical responses than ketotifen, showing improved exhaled nitric oxide, peak expiratory flow, and asthma scores in 1 wk. After 8-wk of medication, both ketotifen and montelukast revealed improved clinical responses. However, 8 wk of ketotifen, but not montelukast, decreased plasma serum thymus and activation-regulated chemokine (317.854 ± 207.906 vs. 181.348 ± 167.109, p < 0.05), macrophage-derived chemokine (355.11 ± 174.30 vs. 169.19 ± 62.42, p < 0.05) levels. In conclusion, different oral non-steroidal anti-inflammatory drugs revealed faster or slower treatment responses due to different mechanisms. [ABSTRACT FROM AUTHOR]

The aim of this intervention study was to identify any health improvements in the upper and lower airways of office workers after the installation of local electrostatic air cleaners. Eighty persons with airways symptoms were recruited and randomly assigned to an intervention or control group. Half of the air cleaners had a non-functioning electrostatic unit. Both participants and field researchers were blinded to the group status. Subjective symptoms were recorded using a questionnaire, and indexes calculated for general, irritation and skin symptoms. Objective respiratory health indicators were recorded, with acoustic rhinometry and peak expiratory flow (PEF) meters. In the intervention group there was a decrease in mean dust concentration from 65 to 35 μg/m3, and a reduction from 57 to 47 μg/m3 in the control group (P < 0.05 for difference in decline). The reduction was observed for all particles sizes. The irritation and general symptom indices decreased in both groups, but there was no improvement in the intervention group, compared with the control group. Median PEF increased 3 ml/s in the intervention group, and decreased 4 ml/s in the control group. The adjusted odds ratio for an increase above the 70th percentile was 5.7 (95% CI 1.0–32). Electrostatic air cleaners can reduce the dust concentration effectively in the office environment. Small, medium and large sized particles can be reduced by approximately 50%, relatively most effectively for the respirable particles. However, the air cleaners tested in this study produced an annoying fan noise. Cleaning efficiency and noise data should be given consideration before installation. This experimental field study suggests that office workers with airways symptoms may benefit from installation of local electrostatic air cleaners. [ABSTRACT FROM AUTHOR]

Study Objective. To determine if gender differences in the skill of using peak flow meters affect peak expiratory flow (PEF). Design. Prospective observational study. Setting. University classroom. Subjects. One hundred sixteen first-year pharmacy students (76 women, 40 men). Intervention. Students were taught correct use of a peak flow meter by means of classroom discussion and demonstrations. Measurements and Main Results. The students' technique in use of the peak flow meter was scored 3 times, and their PEF was recorded. Men scored higher than women (p=0.03) for the steps of "inhale fully" and "exhale as hard and as fast as you can" in the first attempt. Percentage increases in PEF did not significantly differ between the groups. Percentage change in PEF improved from the second attempt to the third attempt in women (p=0.036) but not men. On the third attempt, 13.2% of women versus 2.6% of men had an increase in PEF of more than 50% (p=0.1). Conclusion. This study found that men learned the correct technique for using a peak flow meter and attained their best PEF more quickly than women. [ABSTRACT FROM AUTHOR]

To determine which diary card variables are the most predictive for administration of additional courses of corticosteroids using theTRUST(The Regular Use of Salbutamol Trial) data set.Logistic regression models were used to identify the extent to which a change in diary card variable affected the odds ratio (OR) for administering a course of oral or increased inhaled corticosteroids. The completeTRUSTdiary card data were used with over 200 000 days of diary card observations from 983 mild to moderate asthmatic subjects.An increase in daytime symptoms of 1–5 U over baseline was associated with an increase in the OR for starting all types of corticosteroids from two- to 60-fold.These results indicate that an increase in daytime symptoms of two or more over baseline strongly predicts the administration of additional corticosteroids. The results have significant implications for both clinical practice and design of clinical trials in asthma. [ABSTRACT FROM AUTHOR]

Objective: International consensus guidelines suggest that in asthma and chronic obstructive pulmonary disease (COPD), measurements of FEV1 and PEF are equivalent in the assessment of the degree of airflow obstruction when expressed as the per cent of predicted values. Methodology: In this retrospective study, 2587 paired measurements of PEF and FEV1 performed by 101 adult patients with asthma (n = 56) and COPD (n = 45) attending an outpatient chest clinic were obtained. The mean differences between FEV1 and PEF measurements when expressed as the percentage of predicted values was determined. The level of agreement between the two measurements in the classification of asthma severity (life-threatening, severe, moderate and mild asthma determined by PEF or FEV1 measurements of <30%, 30–60%, 60–80%, and >80% of the predicted values, respectively) was determined. Results: There was considerable variability between measurements of FEV1 and PEF when expressed as % predicted values. In both asthma and COPD, the FEV1 % predicted was smaller than the PEF % predicted, with the mean difference being –10.9% (95% CI, –12.8% to –8.9%) with limits of agreement of –35.4% to +13.6%. The weighted Kappa statistic for agreement was 0.59 (95% CI, 48–70%) in the classification of the severity of airflow obstruction. Conclusion: When expressed as percentage of predicted values, PEF and FEV1 values are not equivalent. We recommend that guidelines be modified to state that across the spectrum of the severity of airflow obstruction there is considerable variability between measurements of FEV1 and PEF when expressed as % predicted such that the FEV1 may be as much as 35% lower or up to 15% higher than the PEF for patients with obstructive lung diseases. [ABSTRACT FROM AUTHOR]

A case in which a home peak expiratory flow (PEF) monitoring device was recommended led us to review the evidence examining this intervention. The clinical question to be answered was: should these devices be consistently recommended to all patients with asthma? A comprehensive search revealed eight randomized controlled trials, one review and one consensus report. Four trials provided all subjects with asthma education and compared patient-specific action plans based on symptoms to those based on PEF readings. Four trials compared usual asthma care to peak flow monitoring (PFM) and varied in both their content and intensity of asthma education. Six out of eight studies showed improvement in some selected markers of asthma morbidity with home PFM-based action plans. Improvements were also observed in patients using a symptom-based action plan. These studies did not demonstrate any obvious advantage of PFM compared with symptom-based monitoring but did suggest that a monitoring plan with predetermined actions based on PEF measurements or symptoms can lead to improved asthma control. Although not specifically studied, PFM may be more appropriate and effective for patients who have difficulty identifying worsening of asthma control through symptom monitoring. [ABSTRACT FROM AUTHOR]

We examined the performance of a number of laboratory tests in 23 patients who had had symptoms suggesting asthma, such as cough, sputum secretion, and chest tightness with wheezing, for less than a year. Even the best test, histamine challenge, had a sensitivity of only 48%. When more tests were added, sensitivity rose: with peak expiratory flow added, the sensitivity was 65%; with sputum eosinophil cationic protein (ECP) added, to 74%; and with serum ECP added, to 78%. Thus, a combination of tests measuring lung function and activation of eosinophils yielded fair, if not good, results. It appears that sensitivity could be increased further through the development of improved sputum tests. [ABSTRACT FROM AUTHOR]

Aims: To create a reference range of peak expiratory flow (PEF) results of Afro-Caribbean children and determine whether interpretation of PEF results in children with sickle cell anaemia (SCA) differed according to whether comparison was made of results obtained from children of similar age or height. Methods: A prospective observational study was carried out in two specialist sickle cell disease clinics. Seventy-eight nonasthmatic African and Caribbean (AC) controls (age range 2.6–17.8 years), and 99 nonasthmatic SCA children (age range 3.4–17.3 years) were recruited. PEF was measured using a dry rolling sealed spirometer before and after bronchodilator therapy. Results: PEF results in the AC controls correlated with height (r = 0.88, p< 0.0001). Comparison of similarly aged children demonstrated that pre- (p = 0.02) and post- (p = 0.04) bronchodilator PEF results were lower in the SCA children, but comparison of children of similar height revealed no statistically significant differences in PEF results between children with SCA and controls. The SCA children tended to be shorter than the controls. Conclusion: The results suggest PEF measurements are not a useful method of monitoring the respiratory status of children with sickle cell disease. [ABSTRACT FROM AUTHOR]

Whole-body cryotherapy (WBC) is one mode of cold therapy, during which rheumatic patients are exposed to very cold air (−110°C) in minimal clothing. It is also proposed to have a bronchodilatory effect. The aim was to examine the effects of WBC on lung function in healthy humans after acute and repeated exposures. Twenty-five healthy, non-smoking subjects participated in the study. They were exposed to WBC for 2 min three times per week for 12 weeks. The peak expiratory flow rate (PEF) and forced expiratory volume in 1 s (FEV1) were measured before and after (at 2 and 30 min) the first WBC, and then similarly at 4, 8 and 12 weeks. At all time points, after 30 min of the WBC the PEF values were slightly lower compared with values before the WBC, and the reductions reached statistical significance at 1 month (5·1 ± 1·2%), and at 3 months (3·2 ± 1·7%). After 30 min of the first WBC, the FEV1 was significantly reduced by 2·3 ± 0·8%, but no other changes were observed during the study. In conclusion, the WBC induced minor bronchoconstriction in healthy humans instead of proposed bronchodilatation. The WBC seems not to be harmful for lung function, but should be used with caution in susceptible individuals. [ABSTRACT FROM AUTHOR]