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Pulmonary Rehabilitation |

Peak Expiratory Flow as a Tool for Detecting Pulmonary Impairment in Patients Treated for Pulmonary Tuberculosis

Mikhail Chushkin, MD; Sergey Mandrykin, MD; Svetlana Bukhareva, MD; Sergey Smerdin, MD
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Research Institute of Phthisiopulmonology, Moscow, Russian Federation


Chest. 2013;144(4_MeetingAbstracts):828A. doi:10.1378/chest.1657447
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Abstract

SESSION TITLE: Physiology/PFTs/Rehabilitation Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Tuberculosis is associated with frequent pulmonary impairment. This supports performance of pulmonary function tests in the course of treatment and after a cure but until now pulmonary function testing has not been included in tuberculosis treatment guidelines. The aim of the study was to assess the usefulness of peak expiratory flow (PEF) in predicting pulmonary impairment in patients with treated pulmonary tuberculosis.

METHODS: Pulmonary function was studied with spirometry and bodyplethysmography in 317 patients (between the ages of 20 and 82 years) treated for pulmonary tuberculosis and observed at local tuberculosis dispensaries.

RESULTS: Out of 317 patients, 177 (55,8%) had any pulmonary impairment including 51 (16,1%) patients with restriction (total lung capacity [TLC] <80% predicted), 139 (43,8%) patients with airflow obstruction (forced expiratory volume in 1 second [FEV1]/forced vital capacity [FVC] < 0.7), and 118 patients (37,2%) with low lung function (FEV1 <80% predicted). According Receiver Operating Characteristics (ROC) curve analysis for low lung function, when PEF <70% predicted was chosen as the cut-off, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 80.5%, 88.4%, 80.5%, and 88.4%, respectively. Area under the ROC curve (AUC) was 0,92 (95% confidential interval [CI] 0.89 to 0.95). For restrictive pattern when PEF <80% predicted was chosen as the cut-off, the sensitivity, specificity, PPV and NPV were 94.1%, 52.6%, 27.6%, and 97.9%, respectively. AUC was 0,78 (95% CI 0.73 to 0.83). For obstructive pattern when PEF <73% predicted was chosen as the cut-off, the sensitivity, specificity, PPV and NPV were 68.3%, 77%, 69.9%, and 75.7%, respectively. AUC was 0,79 (95% CI 0.74 to 0.83). For FEV1 <60% predicted (58 out of 317 patients) when PEF <65% predicted was chosen as the cut-off, the sensitivity, specificity, PPV and NPV were 87.9%, 79.9%, 49.5%, and 96.7%, respectively. AUC was 0,93 (95% CI 0.9 to 0.96). For FEV1 <60% predicted when PEF <80% predicted was chosen as the cut-off, the sensitivity, specificity, PPV and NPV were 100%, 55.2%, 33.3%, and 100%, respectively.

CONCLUSIONS: Mechanical PEF may be a sensible way to detect pulmonary impairment in patients treated for pulmonary tuberculosis. PEF <80% predicted (especially less 70% predicted) suggests a high probability of pulmonary impairment.

CLINICAL IMPLICATIONS: PEF <80% predicted is the indication for pulmonary function testing in patients treated for pulmonary tuberculosis.

DISCLOSURE: The following authors have nothing to disclose: Mikhail Chushkin, Sergey Mandrykin, Svetlana Bukhareva, Sergey Smerdin

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