Oga T, Nishimura K, Tsukino M, Hajiro T, Ikeda A
Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Japan.
J Asthma. 2001 Feb;38(1):33-40. doi: 10.1081/jas-100000019.
In the management of patients with asthma, peak expiratory flow (PEF) monitoring is used and based on the individual best PEF or the predicted PEE Recent international guidelines have recommended the use of the best PEF rather than the predicted PEF as an index, although there is little evidence to support which index is more appropriate. Therefore, we investigated the relationship between the best PEF and the predicted PEF in 166 consecutive asthmatic patients to see which value would be the better basis for their PEF monitoring. All eligible patients had undergone treatment for their asthma for over 6 months and were asked to measure their PEF four times a day. The best PEF was defined as the maximal PEF achieved at any time from all previous measurements. The predicted PEF was calculated based on a report on the standard PEF in normal Japanese subjects. The mean best PEF was significantly higher than the mean predicted PEF (p < 0.001). There was a strong correlation between the best PEF and the predicted PEF (r = 0.77, p < 0.001). However, in 72 patients (43%) the ratio of the best PEF to the predicted PEF was over 110%, and in 20 patients (12%) the ratio was lower than 90%. The best PEF was higher than the predicted PEF in 76 patients (46%) and lower in 22 patients (13%) by more than 50 L/min. These results suggest that when the predicted PEF was used as the index, pulmonary function was either underestimated or overestimated in over half of these patients. Therefore, the best PEF may be the better index for the management of patients with asthma.
在哮喘患者的管理中，使用呼气峰值流速（PEF）监测，其基于个体最佳PEF或预测的PEF。最近的国际指南推荐使用最佳PEF而非预测的PEF作为指标，尽管几乎没有证据支持哪个指标更合适。因此，我们调查了166例连续哮喘患者中最佳PEF与预测PEF之间的关系，以确定哪个值更适合作为他们PEF监测的基础。所有符合条件的患者哮喘治疗时间超过6个月，并被要求每天测量4次PEF。最佳PEF定义为所有先前测量中任何时间达到的最大PEF。预测的PEF根据日本正常受试者标准PEF的报告计算。最佳PEF的平均值显著高于预测PEF的平均值（p < 0.001）。最佳PEF与预测PEF之间存在很强的相关性（r = 0.77，p < 0.001）。然而，在72例患者（43%）中，最佳PEF与预测PEF的比值超过110%，在20例患者（12%）中该比值低于90%。76例患者（46%）的最佳PEF高于预测PEF，22例患者（13%）的最佳PEF低于预测PEF超过50 L/min。这些结果表明，当使用预测的PEF作为指标时，超过一半的这些患者的肺功能被低估或高估。因此，最佳PEF可能是哮喘患者管理的更好指标。
