![]() Although, not as reliable as spirometry, a peak flow meter is a recommended alternative for diagnosis of asthma. ![]() Compared to spirometry, peak flow measurements are less-time consuming, are not dependent on trained manpower, easy for patients to perform and are less costly. The peak flow meter is a simple, easy to use tool that measures peak expiratory flow (PEF) and detects airflow limitation. Also, in real-life practice, primary care practitioners are required to diagnose both asthma and COPD and hence, there is a need for a single questionnaire for detection of both asthma and COPD. However, these questionnaires are relatively large and scoring system is complex. The COPD diagnostic questionnaire has been tested for diagnosing COPD in primary care practice. The questionnaires for asthma have been tested for assessing prevalence of asthma in the community. 6, 7, 8, 9 The sensitivity and specificity reported using these tools ranged between 50 and 96% depending on the criteria used for the diagnosis. There have been several attempts to develop simpler diagnostic tools with reasonable sensitivity and specificity that can help detect asthma and COPD in the community and in primary care practice. However, spirometry is poorly used in India for several reasons including lack of time, cost, lack of availability, and lack of knowledge. 4 The most commonly used objective tool to diagnose asthma and COPD is spirometry. 1, 2, 3 In India, >95% of patients with COPD remain undiagnosed and around 50% of patients diagnosed to have COPD, may not necessarily have COPD. Around 70% of asthmatics in the population aged more than 40 years remain undiagnosed and around 30% of patients diagnosed to have asthma do not have asthma. Mini-spirometers are useful in detection of obstructive airways diseases but FEV 1 measured is inaccurate.Īsthma and chronic obstructive pulmonary disease (COPD) present to a clinician in various forms and usually with non-specific symptoms and signs, leading to significant under-diagnosis and mis-diagnosis. ![]() Peak flow meter with few symptom questions can be effectively used in clinical practice for objective detection of asthma and chronic obstructive pulmonary disease, in the absence of good quality spirometry. At a cut-off of 0.75, the FEV 1/FEV 6 had the best accuracy (Sn 80%, Sp 86%) to detect airflow limitation. Respiratory symptoms with PEF < 80% predicted, had Sn 84 and Sp 93% to detect OAD. A peak expiratory flow of < 80% predicted was the best cut-off to detect airflow limitation (Sn 90%, Sp 50%). “Asymptomatic period > 2 weeks” had the best sensitivity (Sn) and specificity (Sp) to differentiate asthma and chronic obstructive pulmonary disease. “Breathlessness > 6months” and “cough > 6months” were important symptoms to detect obstructive airways disease. One eighty nine patients (78 females) with age 51 ± 17 years with asthma (115), chronic obstructive pulmonary disease (33) and others (41) completed the study. Physician made a final diagnosis of asthma, chronic obstructive pulmonary disease and others. Spirometry was repeated after bronchodilation. Two hundred consecutive patients with respiratory complaints answered a short symptom questionnaire and performed peak expiratory flow measurements, standard spirometry with Koko spirometer and mini-spirometry (COPD-6). However, the accuracy of these tools together, in clinical settings for disease diagnosis, has not been studied. ![]()
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