Koyama H, Nishimura K, Ikeda A, Tsukino M, Izumi T
Chest Disease Research Institute, Kyoto University, Japan.
Respir Med. 1998 Mar;92(3):505-11. doi: 10.1016/s0954-6111(98)90299-2.
Ambulatory peak flow monitoring plays an important role in the diagnosis and management of patients with bronchial asthma. Today several kinds of portable peak flow meters (PFMs) are available for this purpose and sometimes comparisons between the readings of different kinds of PFMs are necessary in clinical setting. We compared four types of PFMs in patients with various respiratory diseases. The study population consisted of 294 patients with asthma, chronic obstructive pulmonary disease, diffuse panbronchiolitis and other respiratory systems, and 15 healthy volunteers. Initially, subjects underwent a spirometry until at least three acceptable forced expiratory curves were obtained. Thereafter each subject blew into a Mini-Wright meter, Assess meter, Pulmo-graph meter and Wright Pocket meter, three times in a random order, with an interval of 4 min. The highest value of three blows was recorded in each PFM measurement. Finally, a second set of spirometric measurements were obtained. Spirometric peak flow rates (PEFRs) were obtained from the best single test which gave the largest sum of forced vital capacity and forced expiratory volume in 1 s (FEV1). In cases when FEV1 in the first spirometry examination was less than 11 or the readings of the PFM were less than 3501 min-1, low-range PFMs were used. The second spirometric PEFR was used as a standard against which the reading of the PFM was compared. The correlation coefficients between the readings of each PFM and spirometric PEFR did not differ significantly from each other. The limits of agreement between each PFM were very wide. In both low- and standard-range PFM, the Assess meter had a significantly greater absolute difference from the spirometric PEFR than other PFMs. In the standard range, the Wright Pocket meter also had a greater difference than the Pulmo-graph meter. The standard-range Assess meter tended to lose its strength of correlation with the spirometric measurement at higher flow rates as did the low-range Pulmo-graph and Mini-Wright meters at the lower and higher flow rates, respectively. All four types of standard-range PFMs gave similarly valid values when spirometric PEFR was used as a reference. However, the limit of agreement between each PFM is so wide that we do not recommend the use of the readings of each meter interchangeably.
动态峰值流速监测在支气管哮喘患者的诊断和管理中起着重要作用。如今，有几种便携式峰值流速仪（PFM）可用于此目的，并且在临床环境中有时需要比较不同类型PFM的读数。我们比较了患有各种呼吸系统疾病患者的四种类型的PFM。研究人群包括294例患有哮喘、慢性阻塞性肺疾病、弥漫性泛细支气管炎和其他呼吸系统疾病的患者以及15名健康志愿者。最初，受试者进行肺活量测定，直到获得至少三条可接受的用力呼气曲线。此后，每个受试者以随机顺序向Mini-Wright仪、Assess仪、Pulmo-graph仪和Wright Pocket仪吹气三次，间隔4分钟。每次PFM测量记录三次吹气中的最高值。最后，获得第二组肺活量测定值。肺活量峰值流速（PEFR）从最佳单次测试中获得，该测试给出了最大的用力肺活量和1秒用力呼气量（FEV1）之和。在第一次肺活量测定检查中FEV1小于11或PFM读数小于350升/分钟的情况下，使用低量程PFM。第二次肺活量测定的PEFR用作与PFM读数进行比较的标准。每种PFM读数与肺活量测定PEFR之间的相关系数彼此之间没有显著差异。每种PFM之间的一致性界限非常宽。在低量程和标准量程PFM中，Assess仪与肺活量测定PEFR的绝对差异均显著大于其他PFM。在标准量程中，Wright Pocket仪与Pulmo-graph仪相比也有更大差异。标准量程的Assess仪在较高流速下与肺活量测定的相关性趋于减弱，低量程的Pulmo-graph仪和Mini-Wright仪分别在较低和较高流速下也是如此。当以肺活量测定PEFR作为参考时，所有四种类型的标准量程PFM给出的有效值相似。然而，每种PFM之间的一致性界限如此之宽，以至于我们不建议互换使用每种仪器的读数。
