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Intern Med. 2008;47(12):1107-12. Epub 2008 Jun 16.

Peak expiratory flow variability adjusted by forced expiratory volume in one second is a good index for airway responsiveness in asthmatics.

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  • 1The Third Department of Internal Medicine, Wakayama Medical University, School of Medicine, Wakayama.



The lowest peak expiratory flow (PEF) over a week, expressed as a percentage of the highest PEF (Min%Max PEF) has been reported to be the index that most closely correlates with airway hyperresponsiveness (AHR) in asthmatics. However, both fluctuation of the airway caliber and airflow limitation are regarded as physiological properties of asthma closely related to AHR. An accurate index that shows the degree of AHR may be obtained by combining the index of airway lability with the parameters that represent airway caliber.


Ninety-two steroid-naive and twenty-eight steroid-treated asthmatic patients were enrolled. Using the physiological parameters obtained from spirometry and PEF monitoring, we investigated the indices which correlate accurately with airway responsiveness measured by the inhalation challenge test.


Although the methacholine threshold was related to all parameters that represent airway caliber and lability, Min%Max PEF had the strongest correlation with AHR. When Min%Max PEF was adjusted by the airway geometric factors, the normalization of Min%Max PEF with forced expiratory volume in one second as a percentage of the predicted value (%FEV(1)) improved the relationship between Min%Max PEF and AHR.


Min%Max PEF adjusted by %FEV(1) showed a good correlation with airway responsiveness measured by the inhalation challenge test, and may be useful as a convenient alternative index of AHR in asthmatic patients.

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