Skip to main content
NCBI home page
Thorax logoLink to Thorax
. 1993 Dec;48(12):1211–1217. doi: 10.1136/thx.48.12.1211

How many times per day should peak expiratory flow rates be assessed when investigating occupational asthma?

J L Malo 1, J Côté 1, A Cartier 1, L P Boulet 1, J L'Archevêque 1, M Chan-Yeung 1
PMCID: PMC464971  PMID: 8303625

Abstract

BACKGROUND--Serial peak expiratory flow rate (PEF) recording has been advocated as a sensitive and specific means of confirming work related asthma. The optimum number of recordings per day to achieve the best between-reader and within-reader reproducibility and sensitivity/specificity ratio compared with the final diagnosis determined by specific inhalation challenges is unknown. METHODS--PEF recording was carried out every two hours in 74 subjects referred for possible occupational asthma. Specific inhalation challenges performed in a hospital laboratory or at the workplace (positive in 33 subjects and negative in 41) were considered the gold standard. The duration of monitoring at work and away from work was at least two weeks each. Graphs of PEF recordings were generated in four different ways: every two hours, four times/day, three times/day, and every morning and evening. The graphs were assessed by three readers in three different centres in a blind manner. Furthermore, one third of each type of graph was read blind by the same reader one week after the initial interpretation. RESULTS--Agreement between the three readers was a little more frequent (82%) in the case of the every two hour readings than for the other types of readings (70% v 77%). Agreement between at least two of the three readers occurred in 73% of positive challenges (sensitivity) and in 78% of negative challenges (specificity) for every two hour readings. The figures varied from 61% to 70% for positive challenges and from 78% to 88% for negative challenges for the other types of readings. Within-subject reproducibility from one reading to the next (one week apart) was excellent (83% to 100%). CONCLUSIONS--Recording PEF every two hours results in a slightly more satisfactory agreement between readers and in concordance in terms of sensitivity/specificity than less frequent PEF readings, although the four times a day assessment is almost as satisfactory.

Full text

PDF
1211

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bardy J. D., Malo J. L., Séguin P., Ghezzo H., Desjardins J., Dolovich J., Cartier A. Occupational asthma and IgE sensitization in a pharmaceutical company processing psyllium. Am Rev Respir Dis. 1987 May;135(5):1033–1038. doi: 10.1164/arrd.1987.135.5.1033. [DOI] [PubMed] [Google Scholar]
  2. Burge P. S., O'Brien I. M., Harries M. G. Peak flow rate records in the diagnosis of occupational asthma due to colophony. Thorax. 1979 Jun;34(3):308–316. doi: 10.1136/thx.34.3.308. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Burge P. S., O'Brien I. M., Harries M. G. Peak flow rate records in the diagnosis of occupational asthma due to isocyanates. Thorax. 1979 Jun;34(3):317–323. doi: 10.1136/thx.34.3.317. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bérubé D., Cartier A., L'Archevêque J., Ghezzo H., Malo J. L. Comparison of peak expiratory flow rate and FEV1 in assessing bronchomotor tone after challenges with occupational sensitizers. Chest. 1991 Apr;99(4):831–836. doi: 10.1378/chest.99.4.831. [DOI] [PubMed] [Google Scholar]
  5. Cartier A., Grammer L., Malo J. L., Lagier F., Ghezzo H., Harris K., Patterson R. Specific serum antibodies against isocyanates: association with occupational asthma. J Allergy Clin Immunol. 1989 Oct;84(4 Pt 1):507–514. doi: 10.1016/0091-6749(89)90364-3. [DOI] [PubMed] [Google Scholar]
  6. Cartier A., Malo J. L., Forest F., Lafrance M., Pineau L., St-Aubin J. J., Dubois J. Y. Occupational asthma in snow crab-processing workers. J Allergy Clin Immunol. 1984 Sep;74(3 Pt 1):261–269. doi: 10.1016/0091-6749(84)90256-2. [DOI] [PubMed] [Google Scholar]
  7. Cartier A., Pineau L., Malo J. L. Monitoring of maximum expiratory peak flow rates and histamine inhalation tests in the investigation of occupational asthma. Clin Allergy. 1984 Mar;14(2):193–196. doi: 10.1111/j.1365-2222.1984.tb02652.x. [DOI] [PubMed] [Google Scholar]
  8. Chan-Yeung M., Barton G. M., MacLean L., Grzybowski S. Occupational asthma and rhinitis due to Western red cedar (Thuja plicata). Am Rev Respir Dis. 1973 Nov;108(5):1094–1102. doi: 10.1164/arrd.1973.108.5.1094. [DOI] [PubMed] [Google Scholar]
  9. Chan-Yeung M., Lam S., Koener S. Clinical features and natural history of occupational asthma due to western red cedar (Thuja plicata). Am J Med. 1982 Mar;72(3):411–415. doi: 10.1016/0002-9343(82)90497-1. [DOI] [PubMed] [Google Scholar]
  10. Cloutier Y., Lagier F., Lemieux R., Blais M. C., St-Arnaud C., Cartier A., Malo J. L. New methodology for specific inhalation challenges with occupational agents in powder form. Eur Respir J. 1989 Sep;2(8):769–777. [PubMed] [Google Scholar]
  11. Cockcroft D. W., Cartier A., Jones G., Tarlo S. M., Dolovich J., Hargreave F. E. Asthma caused by occupational exposure to a furan-based binder system. J Allergy Clin Immunol. 1980 Dec;66(6):458–463. doi: 10.1016/0091-6749(80)90006-8. [DOI] [PubMed] [Google Scholar]
  12. Cockcroft D. W., Killian D. N., Mellon J. J., Hargreave F. E. Bronchial reactivity to inhaled histamine: a method and clinical survey. Clin Allergy. 1977 May;7(3):235–243. doi: 10.1111/j.1365-2222.1977.tb01448.x. [DOI] [PubMed] [Google Scholar]
  13. Côté J., Kennedy S., Chan-Yeung M. Sensitivity and specificity of PC20 and peak expiratory flow rate in cedar asthma. J Allergy Clin Immunol. 1990 Mar;85(3):592–598. doi: 10.1016/0091-6749(90)90098-o. [DOI] [PubMed] [Google Scholar]
  14. Côté J., Kennedy S., Chan-Yeung M. Sensitivity and specificity of PC20 and peak expiratory flow rate in cedar asthma. J Allergy Clin Immunol. 1990 Mar;85(3):592–598. doi: 10.1016/0091-6749(90)90098-o. [DOI] [PubMed] [Google Scholar]
  15. Hargreave F. E., Dolovich J., Newhouse M. T. The assessment and treatment of asthma: a conference report. J Allergy Clin Immunol. 1990 Jun;85(6):1098–1111. doi: 10.1016/0091-6749(90)90056-a. [DOI] [PubMed] [Google Scholar]
  16. Hetzel M. R., Clark T. J., Branthwaite M. A. Asthma: analysis of sudden deaths and ventilatory arrests in hospital. Br Med J. 1977 Mar 26;1(6064):808–811. doi: 10.1136/bmj.1.6064.808. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Hudson P., Cartier A., Pineau L., Lafrance M., St-Aubin J. J., Dubois J. Y., Malo J. L. Follow-up of occupational asthma caused by crab and various agents. J Allergy Clin Immunol. 1985 Nov;76(5):682–688. doi: 10.1016/0091-6749(85)90671-2. [DOI] [PubMed] [Google Scholar]
  18. Lam S., Wong R., Yeung M. Nonspecific bronchial reactivity in occupational asthma. J Allergy Clin Immunol. 1979 Jan;63(1):28–34. doi: 10.1016/0091-6749(79)90158-1. [DOI] [PubMed] [Google Scholar]
  19. Malo J. L., Boulet L. P., Dewitte J. D., Cartier A., L'Archevêque J., Côté J., Bédard G., Boucher S., Champagne F., Tessier G. Quality of life of subjects with occupational asthma. J Allergy Clin Immunol. 1993 Jun;91(6):1121–1127. doi: 10.1016/0091-6749(93)90313-5. [DOI] [PubMed] [Google Scholar]
  20. Malo J. L., Cartier A. Occupational asthma in workers of a pharmaceutical company processing spiramycin. Thorax. 1988 May;43(5):371–377. doi: 10.1136/thx.43.5.371. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Malo J. L., Dewitte J. D., Cartier A., Ghezzo H., L'Archevêque J., Boulet L. P., Côté J., Bédard G., Boucher S., Champagne F. Le système québécois d'indemnisation pour asthme professionnel. Description, efficacité et coûts. Rev Mal Respir. 1993;10(4):313–323. [PubMed] [Google Scholar]
  22. Malo J. L., Ghezzo H., L'Archevêque J., Lagier F., Perrin B., Cartier A. Is the clinical history a satisfactory means of diagnosing occupational asthma? Am Rev Respir Dis. 1991 Mar;143(3):528–532. doi: 10.1164/ajrccm/143.3.528. [DOI] [PubMed] [Google Scholar]
  23. Malo J. L., Pineau L., Cartier A., Martin R. R. Reference values of the provocative concentrations of methacholine that cause 6% and 20% changes in forced expiratory volume in one second in a normal population. Am Rev Respir Dis. 1983 Jul;128(1):8–11. doi: 10.1164/arrd.1983.128.1.8. [DOI] [PubMed] [Google Scholar]
  24. Mapp C. E., Corona P. C., De Marzo N., Fabbri L. Persistent asthma due to isocyanates. A follow-up study of subjects with occupational asthma due to toluene diisocyanate (TDI). Am Rev Respir Dis. 1988 Jun;137(6):1326–1329. doi: 10.1164/ajrccm/137.6.1326. [DOI] [PubMed] [Google Scholar]
  25. Pepys J., Hutchcroft B. J. Bronchial provocation tests in etiologic diagnosis and analysis of asthma. Am Rev Respir Dis. 1975 Dec;112(6):829–859. doi: 10.1164/arrd.1975.112.6.829. [DOI] [PubMed] [Google Scholar]
  26. Smith A. B., Bernstein D. I., London M. A., Gallagher J., Ornella G. A., Gelletly S. K., Wallingford K., Newman M. A. Evaluation of occupational asthma from airborne egg protein exposure in multiple settings. Chest. 1990 Aug;98(2):398–404. doi: 10.1378/chest.98.2.398. [DOI] [PubMed] [Google Scholar]
  27. Turner-Warwick M. On observing patterns of airflow obstruction in chronic asthma. Br J Dis Chest. 1977 Apr;71(2):73–86. doi: 10.1016/0007-0971(77)90086-9. [DOI] [PubMed] [Google Scholar]
  28. Vandenplas O., Malo J. L., Cartier A., Perreault G., Cloutier Y. Closed-circuit methodology for inhalation challenge tests with isocyanates. Am Rev Respir Dis. 1992 Mar;145(3):582–587. doi: 10.1164/ajrccm/145.3.582. [DOI] [PubMed] [Google Scholar]
  29. Venables K. M., Burge P. S., Davison A. G., Newman Taylor A. J. Peak flow rate records in surveys: reproducibility of observers' reports. Thorax. 1984 Nov;39(11):828–832. doi: 10.1136/thx.39.11.828. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Woolcock A., Rubinfeld A. R., Seale J. P., Landau L. L., Antic R., Mitchell C., Rea H. H., Zimmerman P. Thoracic society of Australia and New Zealand. Asthma management plan, 1989. Med J Aust. 1989 Dec 4;151(11-12):650–653. [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES