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Obstructive Lung Diseases |

Can Peak Flow (PEF) Aid in the Identification of Undiagnosed Clinically-Significant COPD?

David Mannino, MD; Fernando Martinez, MD; Nancy Leidy, PhD; Elizabeth Bacci, PhD; R Barr, MD; Russ Bowler, MD; Meilan Han, MD; Julia Houfek, PhD; Karen Malley, BA; Catherine Meldrum, PhD; Stephen Rennard, MD; Byron Thomashow, MD; John Walsh; Barbara Yawn, MD
Author and Funding Information

University of Kentucky, Lexington, KY


Chest. 2015;148(4_MeetingAbstracts):697A. doi:10.1378/chest.2273053
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Abstract

SESSION TITLE: COPD Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: This study examined the clinical validity of peak flow (PEF) as part of an approach (questionnaire + peak expiratory flow [PEF]) to help clinicians identify patients in need of diagnostic evaluation for clinically significant COPD (FEV1 < 60% predicted or at risk of exacerbation).

METHODS: Prospective, cross-sectional, multi-site case-control study. Subjects: ≥ 40 years recruited through US pulmonary and primary care clinics. Cases: Group 1: ≥ 1 exacerbation past 12 months; Group 2: FEV1 < 60% predicted, exacerbation free ≥ 12 months. Controls: Group 3: no COPD; Group 4: mild COPD, exacerbation free ≥ 12 months. Subjects completed a questionnaire booklet, PEF (3 maneuvers), and spirometry (if not on record).

RESULTS: N=346 (186 Cases, 160 Controls). Mean (SD) age=62.7 (10.1) years; 55% female; 86% white; 41% ≤ high school; 17% never smoked. Cases: FEV1% pred = 42.5 (14.2); Controls=82.5 (15.7). PEF (L/M; n=344) significantly correlated with FEV1 = 0.82, FEV1% pred = 0.70, FEV/FVC = 0.64 (p<0.0001); and differentiated GOLD (F=61.72, p<0.0001) and COPD Foundation categories (F=53.93, p<0.0001). It also distinguished Cases and Controls (202.2 [85.5] L/min & 363.6 [114.6] L/min; n=344; t=14.63, p<0.0001) and Groups (ANCOVA F=52.95, p<0.0001); Groups 1 or 2 versus 3 or 4, Tukey-Kramer adjustment, p<0.0001), but could not differentiate Groups 1 and 2.

CONCLUSIONS: PEF exhibited evidence of validity as an indicator of airway obstruction, but could not differentiate exacerbators and non-exacerbators, supporting the use of additional assessment questions to identify patients who may have undiagnosed COPD with exacerbation risk.

CLINICAL IMPLICATIONS: PEF can assist in the identification of patients in need of spirometric evaluation for COPD, but should not be used to identify patients at risk of exacerbation.

DISCLOSURE: David Mannino: Grant monies (from industry related sources): Glaxo SmithKline, Grant monies (from industry related sources): Novartis, Consultant fee, speaker bureau, advisory committee, etc.: GlaxoSmithKline, Consultant fee, speaker bureau, advisory committee, etc.: Novartis, Consultant fee, speaker bureau, advisory committee, etc.: Boehringer-Ingelhiem, Consultant fee, speaker bureau, advisory committee, etc.: Astra-Zeneca, Consultant fee, speaker bureau, advisory committee, etc.: Sunovion, Consultant fee, speaker bureau, advisory committee, etc.: Amgen, Consultant fee, speaker bureau, advisory committee, etc.: Up-to-Date, Other: Expert Witness- Various Law firms, Other: Board of Directors, COPD Foundation Fernando Martinez: Consultant fee, speaker bureau, advisory committee, etc.: Boehringer Ingelheim, Other: CME Incite (CME presentations), Other: CSAII CME presentation, Consultant fee, speaker bureau, advisory committee, etc.: Forest, Consultant fee, speaker bureau, advisory committee, etc.: Genentech, Other: Gilead IPF Steering Committee, Consultant fee, speaker bureau, advisory committee, etc.: Haymarket research, Consultant fee, speaker bureau, advisory committee, etc.: Ikaria/Bellerophon, Other: Janssens ad board and SC, Consultant fee, speaker bureau, advisory committee, etc.: Veracyte, Other: Medscape and WebMD CME presentation, Other: Miller and NACE CME presentations, Other: Nycomed/Takeda ad board/speaking/SC, Consultant fee, speaker bureau, advisory committee, etc.: Pearl, Consultant fee, speaker bureau, advisory committee, etc.: Roche Nancy Leidy: Employee: Employed by Evidera, a health care research firm that provides consulting and other research services to pharmaceutical, device, government, and non-government organizations. In this salaried position, employees work with a variety of companies and organizations and receive no payment or honoraria directly from these organizations for services rendered. Elizabeth Bacci: Employee: Employed by Evidera, a health care research firm that provides consulting and other research services to pharmaceutical, device, government, and non-government organizations. In this salaried position, employees work with a variety of companies and organizations and receive no payment or honoraria directly from these organizations for services rendered. R Barr: Grant monies (from industry related sources): Dr. Barr received grant support from NIH, US-EPA, and the Alpha1 Foundation, Other: Dr. Barr has received royalties from UpToDate Russ Bowler: Consultant fee, speaker bureau, advisory committee, etc.: Boehringer Ingelheim Advisory Board Meilan Han: Consultant fee, speaker bureau, advisory committee, etc.: GSK, Consultant fee, speaker bureau, advisory committee, etc.: BI, Consultant fee, speaker bureau, advisory committee, etc.: Regeneron Karen Malley: Employee: Employed by Evidera, a health care research firm that provides consulting and other research services to pharmaceutical, device, government, and non-government organizations. In this salaried position, employees work with a variety of companies and organizations and receive no payment or honoraria directly from these organizations for services rendered. Stephen Rennard: Consultant fee, speaker bureau, advisory committee, etc.: ABIM, Consultant fee, speaker bureau, advisory committee, etc.: Advantage Heathcare, Consultant fee, speaker bureau, advisory committee, etc.: American Thoracic Society, Other: AstraZeneca, Consultant fee, speaker bureau, advisory committee, etc.: Baxter, Consultant fee, speaker bureau, advisory committee, etc.: Boehringer Ingelheim, Consultant fee, speaker bureau, advisory committee, etc.: Chiesi, Consultant fee, speaker bureau, advisory committee, etc.: ClearView Healthcare, Other: Cleveland Clinic, Consultant fee, speaker bureau, advisory committee, etc.: Complete Medical Group, Consultant fee, speaker bureau, advisory committee, etc.: CSL, Consultant fee, speaker bureau, advisory committee, etc.: Dailchi Sankyo, Consultant fee, speaker bureau, advisory committee, etc.: Decision Resources, Consultant fee, speaker bureau, advisory committee, etc.: Forest, Consultant fee, speaker bureau, advisory committee, etc.: Gerson Lehman Byron Thomashow: Consultant fee, speaker bureau, advisory committee, etc.: consultant Boehringer Ingelheim, Consultant fee, speaker bureau, advisory committee, etc.: advisory board GSK, Consultant fee, speaker bureau, advisory committee, etc.: advisory board Novartis, Consultant fee, speaker bureau, advisory committee, etc.: advisory board AstraZeneca Barbara Yawn: Consultant fee, speaker bureau, advisory committee, etc.: COPD advisory committee for primary care to BI The following authors have nothing to disclose: Julia Houfek, Catherine Meldrum, John Walsh

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