Reporting Peak Expiratory Flow in Older Persons

Overview

Journal J Gerontol A Biol Sci Med Sci

Specialty Geriatrics

Date 2007 Oct 9

PMID 17921429

Citations 23

Authors

Carlos A Vaz Fragoso

Evelyne A Gahbauer

Peter H Van Ness

Thomas M Gill

Affiliations

Soon will be listed here.

Abstract

Background: Peak expiratory flow ("peak flow") predicts important outcomes in older persons. Nevertheless, its clinical application is uncertain because prior strategies for reporting peak flow may not be valid. We thus determined the frequency distribution of peak flow by the conventional strategy of percent predicted (%predicted) and by an alternative method termed standardized residual (SR) percentile, and evaluated how these two metrics relate to health status in older persons.

Methods: Participants included 754 community-dwelling persons aged >/= 70 years. Data included chronic conditions, frailty indicators, and peak flow.

Results: Mean age was 78.4 years, with 63.7% reporting a smoking history, 17.4% chronic lung disease, and 77.1% having one or more frailty indicators. Peak flow >/= 80 %predicted was recorded in 67.5% of participants, whereas peak flow >/= 80th SR percentile was only noted in 15.9%. A graded relationship was observed between peak flow and health status, but %predicted yielded health risk at peak flows currently considered normal (80-100 %predicted), whereas SR percentile conferred health risk only at severely reduced peak flows (< 50th SR percentile).

Conclusions: Peak flow expressed as SR percentile attains a frequency distribution more consistent with the characteristics of our elderly cohort, and establishes health risk at more appropriate levels of reduced peak flow. These findings establish the need for longitudinal studies based on SR percentile to further evaluate the use of peak flow as a risk assessment tool in older persons and to determine if pulmonary function, in general, is better reported in older persons as SR percentile, rather than as %predicted.

Citing Articles

Lower peak expiratory flow rate is associated with a higher risk of pneumonia in patients with stroke.

Wu W, Lin J, Zhou X, Ye S, Shao M, Yu J Eur J Phys Rehabil Med. 2024; 60(6):929-937.

PMID: 39441112 PMC: 11729719. DOI: 10.23736/S1973-9087.24.08475-2.

Population reference equations for handheld peak expiratory flow in older U.S. adults.

Donahue P, Balasubramanian A, Davoudi A, Wanigatunga A, Schrack J, Carlson M Respir Med. 2024; 234:107811.

PMID: 39305967 PMC: 11588502. DOI: 10.1016/j.rmed.2024.107811.

Lung function in relation to brain aging and cognitive transitions in older adults: A population-based cohort study.

Grande G, Li Y, Trevisan C, Rizzuto D, Kalpouzos G, Ding M Alzheimers Dement. 2024; 20(8):5662-5673.

PMID: 38970219 PMC: 11350049. DOI: 10.1002/alz.14079.

Associations between peak expiratory flow and frailty in olderly individuals: findings from the China health and retirement longitudinal study.

Wang R, Shi W, Zhou W, Xu Y, Wang J Front Public Health. 2024; 12:1392581.

PMID: 38864017 PMC: 11165131. DOI: 10.3389/fpubh.2024.1392581.

Frailty as a Marker for the Plasma Concentrations of Direct Oral Anticoagulants in Older Patients: Results of an Exploratory Study.

Eidam A, Marji J, Benzinger P, Foerster K, Burhenne J, Czock D Drugs Aging. 2023; 40(2):153-164.

PMID: 36637788 PMC: 9839390. DOI: 10.1007/s40266-022-00999-y.

References

Quanjer P, LEBOWITZ M, GREGG I, Miller M, Pedersen O . Peak expiratory flow: conclusions and recommendations of a Working Party of the European Respiratory Society. Eur Respir J Suppl. 1997; 24:2S-8S. View

Fabbri L, Pauwels R, Hurd S . Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease: GOLD Executive Summary updated 2003. COPD. 2006; 1(1):105-41. DOI: 10.1081/COPD-120030163. View

Gill T, Desai M, Gahbauer E, Holford T, Williams C . Restricted activity among community-living older persons: incidence, precipitants, and health care utilization. Ann Intern Med. 2001; 135(5):313-21. DOI: 10.7326/0003-4819-135-5-200109040-00007. View

Pellegrino R, Viegi G, Brusasco V, Crapo R, Burgos F, Casaburi R . Interpretative strategies for lung function tests. Eur Respir J. 2005; 26(5):948-68. DOI: 10.1183/09031936.05.00035205. View

Schaub R, Munzberg H, Borchelt M, Nieczaj R, Hillen T, Reischies F . Ventilatory capacity and risk for dementia. J Gerontol A Biol Sci Med Sci. 2000; 55(11):M677-83. DOI: 10.1093/gerona/55.11.m677. View

Castro-Rodriguez J, Holberg C, Morgan W, Wright A, Martinez F . Increased incidence of asthmalike symptoms in girls who become overweight or obese during the school years. Am J Respir Crit Care Med. 2001; 163(6):1344-9. DOI: 10.1164/ajrccm.163.6.2006140. View

Garcia-Rio F, Pino J, Dorgham A, Alonso A, Villamor J . Spirometric reference equations for European females and males aged 65-85 yrs. Eur Respir J. 2004; 24(3):397-405. DOI: 10.1183/09031936.04.00088403. View

Lan T, Melzer D, Tom B, Guralnik J . Performance tests and disability: developing an objective index of mobility-related limitation in older populations. J Gerontol A Biol Sci Med Sci. 2002; 57(5):M294-301. DOI: 10.1093/gerona/57.5.m294. View

Hardie J, Buist A, Vollmer W, Ellingsen I, Bakke P, Morkve O . Risk of over-diagnosis of COPD in asymptomatic elderly never-smokers. Eur Respir J. 2002; 20(5):1117-22. DOI: 10.1183/09031936.02.00023202. View

10.

Gill T, Williams C, Tinetti M . Assessing risk for the onset of functional dependence among older adults: the role of physical performance. J Am Geriatr Soc. 1995; 43(6):603-9. DOI: 10.1111/j.1532-5415.1995.tb07192.x. View

11.

Folstein M, Folstein S, McHugh P . "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12(3):189-98. DOI: 10.1016/0022-3956(75)90026-6. View

12.

Cook N, Evans D, Scherr P, Speizer F, Vedal S, Branch L . Peak expiratory flow rate in an elderly population. Am J Epidemiol. 1989; 130(1):66-78. DOI: 10.1093/oxfordjournals.aje.a115324. View

13.

Whitfield K, Seeman T, Miles T, Albert M, Berkman L, Blazer D . Health indices as predictors of cognition among older African Americans: MacArthur studies of successful aging. Ethn Dis. 1997; 7(2):127-36. View

14.

Cook N, Albert M, Berkman L, Blazer D, Taylor J, Hennekens C . Interrelationships of peak expiratory flow rate with physical and cognitive function in the elderly: MacArthur Foundation studies of aging. J Gerontol A Biol Sci Med Sci. 1995; 50(6):M317-23. DOI: 10.1093/gerona/50a.6.m317. View

15.

. Lung function testing: selection of reference values and interpretative strategies. American Thoracic Society. Am Rev Respir Dis. 1991; 144(5):1202-18. DOI: 10.1164/ajrccm/144.5.1202. View

16.

Gill T, Richardson E, Tinetti M . Evaluating the risk of dependence in activities of daily living among community-living older adults with mild to moderate cognitive impairment. J Gerontol A Biol Sci Med Sci. 1995; 50(5):M235-41. DOI: 10.1093/gerona/50a.5.m235. View

17.

Cook N, Evans D, Scherr P, Speizer F, Taylor J, Hennekens C . Peak expiratory flow rate and 5-year mortality in an elderly population. Am J Epidemiol. 1991; 133(8):784-94. DOI: 10.1093/oxfordjournals.aje.a115957. View

18.

Gill T, Gahbauer E, Allore H, Han L . Transitions between frailty states among community-living older persons. Arch Intern Med. 2006; 166(4):418-23. DOI: 10.1001/archinte.166.4.418. View

19.

Celli B, Halbert R, Isonaka S, Schau B . Population impact of different definitions of airway obstruction. Eur Respir J. 2003; 22(2):268-73. DOI: 10.1183/09031936.03.00075102. View

20.

Quanjer P, Tammeling G, Cotes J, Pedersen O, Peslin R, Yernault J . Lung volumes and forced ventilatory flows. Eur Respir J. 2014; 6 Suppl 16:5-40. DOI: 10.1183/09041950.005s1693. View