Zhonghua Yi Xue Za Zhi. 2026 Aug 25;106(31):3256-3263. doi: 10.3760/cma.j.cn112137-20251230-03481.
ABSTRACT
Objective: To compare the screening efficacy of different evaluation indicators of peak expiratory flow (PEF) for chronic obstructive pulmonary disease (COPD), and to assess the consistency of different evaluation indicators of PEF with forced expiratory volume in one second (FEV1) measured value% predicted value when grading the severity of airflow limitation. Methods: A retrospective analysis was conducted on data from 1 512 patients clinically suspected of COPD who underwent pulmonary function test at the Pulmonary Function Laboratory of China-Japan Friendship Hospital between May 2023 and May 2024. Pulmonary function test results were collected, including post-bronchodilator FEV1/forced vital capacity (FVC), pre-bronchodilator FEV1 measured value% predicted value, pre-bronchodilator PEF measured value, pre-bronchodilator PEF measured value divided by height2, pre-bronchodilator PEF measured value % predicted value, post-bronchodilator PEF measured value, post-bronchodilator PEF measured value/height2, and post-bronchodilator PEF measured value% predicted value. Receiver operating characteristic (ROC) curve was used to evaluate the screening performance of different PEF indicators for detecting impaired lung function, with calculation of the area under the curve (AUC), differences in AUC among indicators, and 95%CI for both AUC values and their differences. Kappa consistency tests were performed to assess agreement between PEF measured value/height2 and PEF measured value% predicted value with FEV1 measured value% predicted value in evaluating the severity of airflow limitation. Results: Among 1 512 clinically suspected patients with COPD, 1 258 were male and 254 were female, with age of (65.68±9.02) years. The AUC (95%CI) for different PEF indicators in screening COPD, ranked from highest to lowest, were as follows: pre-medication PEF measured value% predicted value [0.881 (0.861-0.901)], post-medication PEF measured value% predicted value [0.879 (0.858-0.899)], pre-medication PEF measured value/height2 [0.869 (0.847-0.890)], post-medication PEF measured value/height2 [0.865 (0.843-0.887)], pre-medication PEF measured value [0.843 (0.818-0.867)], and post-medication PEF measured value [0.837 (0.813-0.862)]. After pairwise comparison of the six indicators, it was found that regardless of pre-medication or post-medication, the AUC of PEF measured value was the lowest, followed by PEF measured value/height2, and the AUC of PEF measured value% predicted value was the highest (except for pre-medication PEF measured value/height2 vs post-medication PEF measured value% predicted value: P=0.067, all others P<0.05); and there was no statistically significant difference in the AUC of PEF measured value, PEF measured value/height2, and PEF measured value% predicted value before and after medication (all P>0.05). The predictive performance of different PEF indicators for airflow limitation before medication all showed that in extremely severe, mild, and severe airflow limitation, the AUC of PEF measured value% predicted value was the highest, followed by PEF measured value/height2, and the AUC of PEF measured value was the lowest (all P<0.05). However, in moderate airflow limitation, there was no significant difference in the predictive performance of different PEF indicators before medication (all P>0.05). The consistency of PEF measured value% predicted value and PEF measured value/height2 in evaluating mild airflow limitation was relatively high (Kappa values were 0.671 and 0.611, respectively), and PEF measured value% predicted value was higher than PEF measured value/height2; in moderate, severe, and extremely severe airflow limitation, the consistency of the two indicators with FEV1 measured value% predicted value was moderate or poor. Conclusions: The percentage of the measured PEF value relative to the predicted value demonstrates the highest screening efficacy for COPD and no bronchodilation test is required; with the exception of mild airflow limitation, PEF is not an appropriate alternative to FEV1 for classifying the severity of airflow obstruction.
PMID:42618502 | DOI:10.3760/cma.j.cn112137-20251230-03481
