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

Int J Tuberc Lung Dis. 2009 Mar;13(3):387-93.


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 >or=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 >or=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.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Airway Obstruction / drug therapy
  • Bronchodilator Agents / therapeutic use
  • Female
  • Forced Expiratory Volume
  • Humans
  • Male
  • Middle Aged
  • Peak Expiratory Flow Rate*
  • Pulmonary Disease, Chronic Obstructive / diagnosis*
  • Pulmonary Disease, Chronic Obstructive / drug therapy
  • Sensitivity and Specificity
  • Spirometry* / statistics & numerical data


  • Bronchodilator Agents