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Updated: Jun 25, 2026
06:11
Employing the Forced Oscillation Technique for the Assessment of Respiratory Mechanics in Adults
Published on: February 9, 2022
Can a normal peak expiratory flow exclude severe chronic obstructive pulmonary disease?
R Perez-Padilla1, W M Vollmer, J C Vázquez-García
1Instituto Nacional de Enfermedades Respiratorias, Mexico DF, Mexico. perezpad@servidor.unam.mx
Summary
A normal pre-bronchodilator (pre-BD) peak expiratory flow (PEF) can rule out severe chronic obstructive pulmonary disease (COPD) in at-risk adults. This finding may reduce the need for spirometry testing, improving COPD diagnosis accessibility.
Area of Science:
- Pulmonary Medicine
- Diagnostic Testing
- Epidemiology
Background:
- Chronic obstructive pulmonary disease (COPD) is frequently underdiagnosed.
- Limited spirometry availability is a key barrier to COPD diagnosis.
- Peak expiratory flow (PEF) may serve as a screening tool for COPD in at-risk adults.
Purpose of the Study:
- To determine if post-bronchodilator airway obstruction can be identified using pre-bronchodilator (pre-BD) PEF data.
- To evaluate the utility of pre-BD PEF in ruling out clinically significant COPD.
Main Methods:
- Analysis of data from 13,708 individuals aged 40 years or older from the PLATINO and BOLD studies.
- Evaluation of various pre-BD PEF cut-off points using diagnostic-quality spirometers.
- Inclusion of subjects with at least one COPD risk factor (chronic respiratory symptoms, occupational/environmental exposures, or prior respiratory diagnoses).
Main Results:
- A pre-BD PEF of >=70% predicted effectively ruled out Global Initiative for Chronic Obstructive Lung Disease (GOLD) Stages III and IV COPD.
- Among individuals with at least one risk factor, only 12% required confirmatory spirometry with this criterion.
- The positive predictive value for severe COPD was low, but the negative predictive value was high.
Conclusions:
- Integrating PEF measurement into screening questionnaires can help rule out severe to very severe COPD.
- This approach may obviate the need for pre- and post-bronchodilator spirometry in initial screening.
- Further research is recommended using inexpensive PEF meters or pocket spirometers within a staged screening protocol.
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