Paggiaro P L, Giannini D, Moscato G, Bacci E, Bancalari L, Carrara M, Dente F L, Di Franco A, Di Pede F, Petrozzino M
2nd Institute of Internal Medicine, Respiratory Pathophysiology, Pisa, Italy.
Monaldi Arch Chest Dis. 1994 Dec;49(5):425-31.
The role of peak expiratory flow (PEF) monitoring in the diagnosis of occupational asthma has recently been assessed by several studies, which agree that this procedure should always be used to confirm the relationship between symptoms and occupational exposure. Some specific issues should be satisfied: a minimum number of four PEF measurements in a day; several weeks of monitoring in and out of work; and the presence of specific patterns of PEF changes. The sensitivity and specificity of PEF monitoring to detect occupational asthma, in comparison with the specific challenge test in the laboratory (the "gold standard") have been shown to be fairly high, although many authors believe that PEF monitoring cannot substitute for the specific challenge test. Limitations include: the low sensitivity of PEF to detect mild changes in airway calibre with respect to forced expiratory volume in one second (FEV1); the blunting effect of pharmacological treatment; the episodic and irregular exposure to the sensitizer in the workplace; and the compliance and honesty of the subject. Further studies are required to select the best indices of daily and day-to-day variability to be used in the evaluation of PEF changes between work and out-of-work periods.
近期多项研究评估了呼气峰值流速（PEF）监测在职业性哮喘诊断中的作用，这些研究一致认为，该程序应始终用于确认症状与职业暴露之间的关系。应满足一些特定条件：一天内至少进行四次PEF测量；工作期间和非工作期间均需监测数周；以及存在PEF变化的特定模式。与实验室中的特异性激发试验（“金标准”）相比，PEF监测检测职业性哮喘的敏感性和特异性已被证明相当高，尽管许多作者认为PEF监测不能替代特异性激发试验。其局限性包括：相对于一秒用力呼气量（FEV1），PEF检测气道管径轻微变化的敏感性较低；药物治疗的钝化作用；工作场所中致敏剂的间歇性和不规则暴露；以及受试者的依从性和诚实度。需要进一步研究以选择用于评估工作期间和非工作期间PEF变化的每日和每日间变异性的最佳指标。
