Csonka Leon L, Tikkakoski Antti, Vuotari Liisa, Karjalainen Jussi, Lehtimäki Lauri
Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Department of Clinical Physiology and Nuclear Medicine, Tampere University Hospital, Tampere, Finland.
Pulm Med. 2025 Jul 7;2025:7675935. doi: 10.1155/pm/7675935. eCollection 2025.
Asthma diagnosis can be confirmed by observing significant bronchodilator response (BDR) through peak expiratory flow (PEF) at home or forced expiratory volume in 1 s (FEV) via spirometry in a clinical setting. We aimed to use the administration of salbutamol after a methacholine challenge test as a model of bronchodilation to study how accurately the change in PEF predicts improvement in lung function, as defined by an increase in FEV. We analyzed 869 adult patients who were administered salbutamol after a methacholine challenge. To compare relative changes in PEF and FEV during bronchodilation, we used regression analysis and constructed a Bland and Altman plot. ROC analysis, sensitivity, specificity, positive and negative predictive values, and kappa coefficient assessed how precisely increases in PEF detected a 12% and 0.2-L improvement in FEV. The average relative increase in FEV was significantly greater than that in PEF. The area under the curve in the ROC analysis was 0.844 for PEF change to detect a 12% and 0.2-L increase in FEV. The kappa values for changes in PEF and FEV ranged from fair to moderate. BDR detected by the recommended 15% and 60 L/min cut-off for PEF identified less than half of true positives, while a 10% cut-off correctly identified close to 75% of them. PEF increase is not a reliable measure of BDR in comparison to FEV increase, and a 10% improvement in PEF was the least inaccurate cut-off. Substituting the PEF meter with a handheld spirometer should be further investigated for asthma home monitoring.
通过在家中使用呼气峰值流速（PEF）观察显著的支气管扩张剂反应（BDR），或在临床环境中通过肺量计测量一秒用力呼气量（FEV），可以确诊哮喘。我们旨在将乙酰甲胆碱激发试验后给予沙丁胺醇作为支气管扩张模型，以研究PEF变化预测肺功能改善（定义为FEV增加）的准确程度。我们分析了869例乙酰甲胆碱激发试验后给予沙丁胺醇的成年患者。为了比较支气管扩张期间PEF和FEV的相对变化，我们使用回归分析并构建了布兰德-奥特曼图。ROC分析、敏感性、特异性、阳性和阴性预测值以及kappa系数评估了PEF增加检测FEV增加12%和0.2升改善的精确程度。FEV的平均相对增加显著大于PEF。ROC分析中，PEF变化检测FEV增加12%和0.2升时曲线下面积为0.844。PEF和FEV变化的kappa值从中度到良好不等。推荐的PEF 15%和60升/分钟截断值检测到的BDR识别出的真阳性不到一半，而10%的截断值正确识别了近75%的真阳性。与FEV增加相比，PEF增加不是BDR的可靠测量指标，PEF改善10%是最不准确的截断值。对于哮喘家庭监测，用手持式肺量计替代PEF仪应进一步研究。
