Can a normal peak expiratory flow exclude severe chronic obstructive pulmonary disease?

Rogelio Perez-Padilla, W. M. Vollmer, J. C. Vázquez-García, P. L. Enright, A. M.B. Menezes, A. S. Buist

Research output: Contribution to journalArticlepeer-review

51 Scopus citations


BACKGROUND: Chronic obstructive pulmonary disease (COPD) is underdiagnosed. One barrier to diagnosis is the limited availability of spirometry testing, but in adults at risk for COPD, a normal pre-bronchodilator (pre-BD) peak expiratory flow (PEF) may rule out clinically significant COPD. OBJECTIVE: To identify post-BD airway obstruction using data from 13 708 individuals aged ≥40 years from the PLATINO and BOLD studies. METHODS: We evaluated different cut-off points of pre-BD. The PEF was obtained from a diagnostic-quality spirometer (not a mechanical PEF meter). At least one of the following COPD risk factors was present in 77% of the subjects: chronic respiratory symptoms; exposure to tobacco smoke, biomass smoke or dust in the workplace; or a previous diagnosis of asthma, COPD, emphysema or chronic bronchitis. RESULTS: Although the positive predictive value was low as expected, a pre-BD PEF of ≥70% predicted effectively ruled out Stages III and IV COPD of the Global Initiative for Chronic Obstructive Lung Disease. Among those with at least one risk factor, only 12% would require confirmatory spirometry using this criterion. CONCLUSIONS: Adding PEF measurement to a screening questionnaire may rule out severe to very severe COPD without the need for pre- and post-BD spirometry testing. Confirmation is needed from a study using inexpensive PEF meters or pocket spirometers with a staged screening protocol.

Original languageEnglish (US)
Pages (from-to)387-393
Number of pages7
JournalInternational Journal of Tuberculosis and Lung Disease
Issue number3
StatePublished - Mar 2009


  • BOLD
  • COPD
  • PEF
  • Screening

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Infectious Diseases


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