Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
권호 표지

The Agreements between FEV1 and PEFR in the Patients of Mild Bronchial Asthma

외래 진료가 가능한 경증 천식 환자에서 1초간 노력성 호기량(FEV1)과 최대 호기유속(PEFR)간의 연관성

  • Chang, Won Chul (Department of Internal Medicine, Konkuk University College of Medicine) ;
  • Kim, Byung Kook (Department of Internal Medicine, Konkuk University College of Medicine) ;
  • Kim, Soon Jong (Department of Internal Medicine, Konkuk University College of Medicine) ;
  • Yoo, Kwang Ha (Department of Internal Medicine, Konkuk University College of Medicine) ;
  • Lee, Tae-Hun (Department of Internal Medicine, Konkuk University College of Medicine) ;
  • Lee, Jung Yeon (Department of Internal Medicine, Konkuk University College of Medicine) ;
  • Lee, Kye Young (Department of Internal Medicine, Konkuk University College of Medicine)
  • 장원철 (건국대학교 의과대학 내과학교실) ;
  • 김병국 (건국대학교 의과대학 내과학교실) ;
  • 김순종 (건국대학교 의과대학 내과학교실) ;
  • 유광하 (건국대학교 의과대학 내과학교실) ;
  • 이태훈 (건국대학교 의과대학 내과학교실) ;
  • 이정연 (건국대학교 의과대학 내과학교실) ;
  • 이계영 (건국대학교 의과대학 내과학교실)
  • Received : 2005.09.12
  • Accepted : 2005.10.18
  • Published : 2005.12.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background : Several studies have shown considerable disagreement when using the $FEV_1$ and PEFR to assess the severity of an airflow obstruction. A differential classification of the severity of asthma would lead to serious differences in the evaluation and management of asthma. The aim of this study was to examine the relationship between the $FEV_1$ and PEFR in asthma patients with mild symptoms. Methods : In this study, the PEFR and $FEV_1$ were obtained from 92 adult asthma patients with mild symptoms attending an outpatient pulmonary clinic. The mean differences and the limits of agreement in the paired measurements of the $FEV_1$ and PEFR were calculated. Results : There was a considerable correlation between the $FEV_1$ and PEFR measurements when expressed as a % of the predicted values (r=0.686, p<0.01). The 95% limit of agreement (mean difference ${\pm}1.96SD$) between the $FEV_1$ % and PEFR % were acceptable(-27.4%~33.8%). In addition, the weighted ${\kappa}$(kappa) coefficient for the agreement between the $FEV_1$ % and PEFR % was 0.74 (95% CI, 0.63-0.81), indicating excellent agreement between the two measurements. Conclusion : The spirometer ($FEV_1$) and the Mini-Wright peak flow meter (PEFR) can be used interchangeably in adult asthma patients with mild symptom.

목 적 : 본 연구는 외래에서 진료가 가능한 경도의 천식 환자에서 $FEV_1$ %와 PEFR% 값의 연관성을 알아보고자 시행 하였다. 방 법 : 2003년 9월부터 2004년 8월까지 건국 대학교 병원 호흡기 내과 외래에서 진료를 받은 경증의 기관지 천식 환자들을 대상으로 PEFR과 $FEV_1$를 측정하여 두 검사 값 사이의 연관성을 분석하였다. 결 과 : $FEV_1$ (predicted %)로 경증으로 분류된 87명의 환자 중 PEFR 검사로 82명(94.3%)의 환자가 동일한 경증으로 분류되었고, $FEV_1$ %가 중등증으로 분류된 5명의 환자 중 PEFR로 중증도 분류 시 5명(100%) 모두 동일한 중등증 분류되었다. $FEV_1$ %에 의한 중증도와 PEFR %에 의한 중증도가 일치하지 않는 경우는 전체 92명 중 5명(5.7%)였다. $FEV_1$ %와 PEFR %값의 상관 계수는0.686로(Y= 0.427 + 56.35 X, p<0.01 순상관 관계를 보였고 가중 ${\kappa}$(kappa)상관계수는 0.74 (95% CI, 0.63-0.81)로 일치성을 보였다. 결 론 : 증상이 심하지 않은 경도의 천식 환자에서 PEFR%와 $FEV_1$ %은 높은 일치성을 보여 상호 교환 사용이 가능할 것으로 생각되며, 경도의 증상만 있는 천식 환자에 대해서 폐 기능 검사 기계가 구비되어 있지 않은 의료 기관에서 최대 호기 유속기의 올바른 사용만으로도 정확하고 객관적인 자료를 얻을 수 있을 것으로 판단된다.

Keywords

References

  1. American Thoracic Society. Standard for the diagnosis and care of patients with chronic obstructive pulmonary disease (COPD) and asthma. Am Rev Respir Dis 1987:136:225-44 https://doi.org/10.1164/ajrccm/136.1.225
  2. National Heart, Lung and Blood Institute and World Health Organization. Global Statege for Asthma Management and Prevention: NHLBI/WHO report, revised 2002
  3. The Korean Society of Allergology. The guideline for asthma treatment. Korean J Allergy 1998:18:339-90
  4. Oldman HG, Bevan MM, McDermott M. Comparison of the new miniature Wright peak flow meter with the standard Wright peak flow meter. Thorax 1979:34:807-9 https://doi.org/10.1136/thx.34.6.807
  5. Kimmel SR. Use of the peak flow meter in office practice. Am Fam Physicician 1986:34:107-11
  6. National Heart, Lung and Blood Institute and World Health Organization. Global Statege for Asthma Management and Prevention. NHLBI/WHO report, 1993
  7. Quanjer PH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yernault JC. Lung volumes and forced ventilatory flows. Eur Respir J Suppl 1993:16:5-40
  8. Kim YS, Ran AA, Kim SK, Chang J, Ahn CM, Oh JJ. Peak expiratory flow in normal healthy Korean subjects measured by mini-wright peak flow meter. Tuberc Respir Dis 2001:50:320-33
  9. Nunn AJ, Gregg I. New regression equations for predicting peak expiratory flow in adults. BMJ 1989:298:1068-70 https://doi.org/10.1136/bmj.298.6680.1068
  10. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986:1:307-10
  11. Vaughan TR, Weber RW, Tipton WR, Nelson HS. Comparison of PEFR and FEV1 in patients with varying degrees of airway obstruction: effect of modest altitude. Chest 1989:95: 558-62 https://doi.org/10.1378/chest.95.3.558
  12. Wright BM, McKerrow CB. Maximum forced expiratory flow rate as a measure of ventilatory capacity. Br Med J 1959:21:1041-6
  13. Haydu SP, Chapman TT, Hughes DT. Pulmonary monitor for assessment of airways obstruction. Lancet 1976:2:1225
  14. Clark TJ, Hetzel MR. Diurnal variation of asthma. Br J Dis Chest 1977:71:87-92 https://doi.org/10.1016/0007-0971(77)90087-0
  15. Wiltshire N, Kendrick AH. Evaluation of a new electronic spiromrter: the vitalograph 'Escort' spirometer. Thorax 1994:49:175-8 https://doi.org/10.1136/thx.49.2.175
  16. Gunawardena KA, Houston K, Smith AP. Evaluation of the turbine pocket spirometer. Thorax 1987:42:689-93 https://doi.org/10.1136/thx.42.9.689
  17. Llewellin P, Sawyer G, Lewis S, Cheng S, Weatherall M, Fitzharris P, et al. The relationship between PEF and FEV1 in the assessment of the severity of airway obstruction. Respirology 2002:7:333-7 https://doi.org/10.1046/j.1440-1843.2002.00417.x
  18. Sawyer G, Miles J, Lewis S, Fitzharris P, Pearce N, Beasley R. Classification of asthma severity: should the international guideline be changed? Clin Exp Allergy 1998:28:1565-70 https://doi.org/10.1046/j.1365-2222.1998.00451.x
  19. Lee SW, Choi WI, Park SH, Park HP, Seo YW, Lee JE, et al. Validity of peak expiratory flow for assessing the presence of airflow obstruction. Korean J Med 2004:67:170-5
  20. Pride NB. The assessment of airflow obstruction. Br J Dis Chest 1971:65:135-69 https://doi.org/10.1016/0007-0971(71)90018-0
  21. Li JT. Home peak expiratory flow rate monitoring in patients with asthma. Mayo Clin Proc 1995:70:649-56 https://doi.org/10.4065/70.7.649