Original Articles
Variability in Peak Expiratory Flow Does Not Classify Asthma According to Severity
Eduardo G. Pérez-Yarzaa,
, Nicolás Cobosb, Juan José de la Cruzc, on behalf of the Asthma Working Group of the Spanish Society of Pediatric Pneumology *
Corresponding author
perezyar@chdo.osakidetza.net
Correspondence: Eduardo G. Pérez-Yarza. Unidad de Neumología. Servicio de Pediatría. Hospital Donostia. P.º Dr. Beguiristain, s/n. 20014 San Sebastián. Guipúzcoa. España
Correspondence: Eduardo G. Pérez-Yarza. Unidad de Neumología. Servicio de Pediatría. Hospital Donostia. P.º Dr. Beguiristain, s/n. 20014 San Sebastián. Guipúzcoa. España
a Unidad de Neumología, Servicio de Pediatría, Hospital Donostia, San Sebastián, Guipúzcoa, Spain
b Unidad de Neumología Infantil y Fibrosis Quística, Hospital Materno-Infantil Vall d'Hebron, Barcelona, Spain
c Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid, Madrid, Spain
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"apellidos" => "Pérez-Yarza" "email" => array:1 [ 0 => "perezyar@chdo.osakidetza.net" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "Nicolás" "apellidos" => "Cobos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] ] 2 => array:3 [ "nombre" => "Juan José" "apellidos" => "de la Cruz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] ] ] 3 => array:2 [ "colaborador" => "on behalf of the Asthma Working Group of the Spanish Society of Pediatric Pneumology" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "fn1" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Unidad de Neumología, Servicio de Pediatría, Hospital Donostia, San Sebastián, Guipúzcoa, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Unidad de Neumología Infantil y Fibrosis Quística, Hospital Materno-Infantil Vall d'Hebron, Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] 2 => array:3 [ "entidad" => "Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Correspondence: Eduardo G. Pérez-Yarza. Unidad de Neumología. Servicio de Pediatría. Hospital Donostia. P.º Dr. Beguiristain, s/n. 20014 San Sebastián. Guipúzcoa. España" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2006-12-23" "fechaAceptado" => "2007-02-20" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec154615" "palabras" => array:6 [ 0 => "Asthma" 1 => "Classification" 2 => "Severity" 3 => "Peak expiratory flow" 4 => "Variability" 5 => "Children" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec154614" "palabras" => array:6 [ 0 => "Asma" 1 => "Clasificación" 2 => "Gravedad" 3 => "Flujo espiratorio máximo" 4 => "Variabilidad" 5 => "Niños" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">The aim of this study was to determine whether variability in peak expiratory flow (PEF) could be used to classify the level of severity of asthma in children.</p> <span class="elsevierStyleSectionTitle">PATIENTS AND METHODS</span><p class="elsevierStyleSimplePara elsevierViewall">We studied 387 boys and girls diagnosed with asthma and classified severity according to clinical criteria (Spanish Society of Pediatric Pneumology). PEF variability was determined using a portable mini- Wright peak flow meter (Clement Clarke International, London, UK; range, 50 L/min–800 L/min) over a 14-day period, with no changes in normal treatment. The following indices were used to calculate PEF variability: <span class="elsevierStyleItalic">1)</span> difference between morning PEF and nighttime PEF, expressed as a percentage of the mean value of the PEF measurements taken on that day; <span class="elsevierStyleItalic">2)</span> minimum PEF rate during a week, expressed as a percentage of the highest value recorded during that week; <span class="elsevierStyleItalic">3)</span> difference between the highest and the lowest PEF values, expressed as a percentage of the highest value; and <span class="elsevierStyleItalic">4)</span> the 10th percentile of PEF values recorded during a week, expressed as a percentage of the highest value recorded during that week. We assessed agreement between clinical classification and PEF variability using the weighted [.kappa] coefficient. We also analyzed the sensitivity and specificity of PEF variability indices for episodic and persistent asthma.</p> <span class="elsevierStyleSectionTitle">RESULTS</span><p class="elsevierStyleSimplePara elsevierViewall">The analysis of levels of agreement between clinical classification of asthma and formulas 1, 2, 3, and 4 gave quadratic weighted κ coefficients of 0.494, 0, 0.488, and 0.346, respectively. The results were similar when patients were grouped and analyzed by type of asthma (episodic or persistent asthma).</p> <span class="elsevierStyleSectionTitle">CONCLUSIONS</span><p class="elsevierStyleSimplePara elsevierViewall">The monitoring of PEF variability, a recommendation common in national and international guidelines on the management of asthma in children, is not valid for classifying severity of asthma in children.</p>" ] "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">El objetivo de este estudio ha sido estudiar si la variabilidad del flujo espiratorio máximo (FEM) permite clasificar el asma en niños por niveles de gravedad.</p> <span class="elsevierStyleSectionTitle">PACIENTES Y MÉTODOS</span><p class="elsevierStyleSimplePara elsevierViewall">Se ha estudiado a 387 niños y niñas diagnosticados de asma, cuya gravedad se clasificó atendiendo a criterios clínicos (Sociedad Española de Neumología Pediátrica). Se determinó la variabilidad del FEM con un medidor portátil (Mini Wright Peak Flow Meter Clement, Clarke International Ltd., Londres, Reino Unido; escala 50-800 l/min) en los 14 días siguientes, sin modificar los tratamientos habituales, según los índices de variabilidad del FEM: <span class="elsevierStyleItalic">1)</span> diferencia entre el FEM de la mañana y el de la noche, expresado como porcentaje del valor medio de las medidas del FEM durante el día; <span class="elsevierStyleItalic">2)</span> mínimo valor del FEM durante una semana, expresado como porcentaje del mejor FEM durante esa semana; <span class="elsevierStyleItalic">3)</span> diferencia del mejor sobre el peor FEM, como porcentaje sobre el mejor, y <span class="elsevierStyleItalic">4)</span> percentil 10 de los valores del FEM durante una semana, expresado como porcentaje del mejor FEM durante esa semana. Se analizó el grado de acuerdo entre la clasificación clínica y la variabilidad del FEM mediante el estudio de la concordancia (índice kappa ponderado). También se efectuó un análisis de sensibilidad y especificidad para el asma episódica y el asma persistente en relación con la variabilidad del FEM.</p> <span class="elsevierStyleSectionTitle">RESULTADOS</span><p class="elsevierStyleSimplePara elsevierViewall">Los niveles de acuerdo entre la clasificación clínica del asma y las fórmulas 1, 2, 3 y 4 mostraron índices kappa ponderados bicuadrados de 0,494, 0, 0,488 y 0,346, respectivamente. Los resultados fueron similares cuando los pacientes se agruparon en asma episódica y asma persistente.</p> <span class="elsevierStyleSectionTitle">CONCLUSIONES</span><p class="elsevierStyleSimplePara elsevierViewall">La medida de la variabilidad del FEM, recomendación común de las guías nacionales e internacionales para el manejo del asma en niños, no es válida para clasificar el asma en niños por niveles de gravedad.</p>" ] ] "NotaPie" => array:2 [ 0 => array:1 [ "nota" => "<p class="elsevierStyleNotepara">This study was partially funded by a GlaxoSmithKline (GSK) Spain research grant to the Asthma Working Group of the Spanish Society of Pediatric Pneumology (SENP). GSK Spain did not participate in the design of the study, data analysis, results, or conclusions. The data are the property of the Asthma Working Group of the SENP.</p>" ] 1 => array:2 [ "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara">The researchers who participated in this study are listed at the end of the article.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:39 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "National Asthma Education and Prevention Program. Expert Panel Report. Guidelines for the Diagnosis and Management of Asthma. National Institutes of Health. National Heart, Lung and Blood Institute. Update on selected topics 2002. NIH Publication n.º 025074, 2003. Available from: http:/www. nhlbi.nih.gov/guidelines/asthma/ index.htm. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 2 | 5 | 7 |
| 2024 October | 34 | 23 | 57 |
| 2024 September | 34 | 16 | 50 |
| 2024 August | 50 | 41 | 91 |
| 2024 July | 29 | 20 | 49 |
| 2024 June | 33 | 24 | 57 |
| 2024 May | 44 | 24 | 68 |
| 2024 April | 20 | 27 | 47 |
| 2024 March | 17 | 13 | 30 |
| 2024 February | 27 | 20 | 47 |
| 2023 March | 3 | 3 | 6 |
| 2023 February | 25 | 22 | 47 |
| 2023 January | 17 | 19 | 36 |
| 2022 December | 27 | 22 | 49 |
| 2022 November | 23 | 28 | 51 |
| 2022 October | 20 | 26 | 46 |
| 2022 September | 24 | 28 | 52 |
| 2022 August | 23 | 36 | 59 |
| 2022 July | 25 | 36 | 61 |
| 2022 June | 27 | 32 | 59 |
| 2022 May | 28 | 36 | 64 |
| 2022 April | 45 | 33 | 78 |
| 2022 March | 62 | 38 | 100 |
| 2022 February | 48 | 26 | 74 |
| 2022 January | 27 | 32 | 59 |
| 2021 December | 35 | 46 | 81 |
| 2021 November | 37 | 51 | 88 |
| 2021 October | 44 | 44 | 88 |
| 2021 September | 32 | 65 | 97 |
| 2021 August | 23 | 24 | 47 |
| 2021 July | 23 | 21 | 44 |
| 2021 June | 27 | 24 | 51 |
| 2021 May | 49 | 25 | 74 |
| 2021 April | 47 | 38 | 85 |
| 2021 March | 22 | 34 | 56 |
| 2021 February | 16 | 20 | 36 |
| 2021 January | 14 | 19 | 33 |
| 2020 December | 15 | 15 | 30 |
| 2020 November | 17 | 15 | 32 |
| 2020 October | 20 | 15 | 35 |
| 2020 September | 29 | 10 | 39 |
| 2020 August | 25 | 11 | 36 |
| 2020 July | 30 | 22 | 52 |
| 2020 June | 29 | 9 | 38 |
| 2020 May | 26 | 12 | 38 |
| 2020 April | 20 | 15 | 35 |
| 2020 March | 15 | 14 | 29 |
| 2020 February | 28 | 11 | 39 |
| 2020 January | 33 | 16 | 49 |
| 2019 December | 41 | 16 | 57 |
| 2019 November | 9 | 13 | 22 |
| 2019 October | 7 | 6 | 13 |
| 2019 September | 10 | 20 | 30 |
| 2019 August | 13 | 7 | 20 |
| 2019 July | 12 | 18 | 30 |
| 2019 June | 10 | 14 | 24 |
| 2019 May | 13 | 28 | 41 |
| 2019 April | 32 | 34 | 66 |
| 2019 March | 11 | 19 | 30 |
| 2019 February | 14 | 20 | 34 |
| 2019 January | 9 | 12 | 21 |
| 2018 December | 11 | 22 | 33 |
| 2018 November | 24 | 10 | 34 |
| 2018 October | 36 | 27 | 63 |
| 2018 September | 9 | 11 | 20 |
| 2018 May | 2 | 0 | 2 |
| 2018 April | 13 | 7 | 20 |
| 2018 March | 2 | 2 | 4 |
| 2018 February | 5 | 7 | 12 |
| 2018 January | 4 | 7 | 11 |
| 2017 December | 7 | 7 | 14 |
| 2017 November | 2 | 8 | 10 |
| 2017 October | 5 | 11 | 16 |
| 2017 September | 8 | 9 | 17 |
| 2017 August | 5 | 15 | 20 |
| 2017 July | 5 | 21 | 26 |
| 2017 June | 5 | 11 | 16 |
| 2017 May | 5 | 12 | 17 |
| 2017 April | 1 | 4 | 5 |
| 2017 March | 1 | 3 | 4 |
| 2017 February | 2 | 6 | 8 |
| 2017 January | 2 | 5 | 7 |
| 2016 December | 5 | 5 | 10 |
| 2016 November | 10 | 9 | 19 |
| 2016 October | 10 | 9 | 19 |
| 2016 September | 9 | 9 | 18 |
| 2016 August | 7 | 3 | 10 |
| 2016 July | 1 | 0 | 1 |
| 2016 March | 1 | 0 | 1 |
| 2016 February | 1 | 0 | 1 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 117 | 17 | 134 |
| 2015 September | 115 | 9 | 124 |
| 2015 August | 110 | 9 | 119 |
| 2015 July | 133 | 10 | 143 |
| 2015 June | 123 | 9 | 132 |
| 2015 May | 94 | 9 | 103 |
| 2015 April | 69 | 10 | 79 |
| 2015 March | 72 | 7 | 79 |
| 2015 February | 84 | 8 | 92 |
| 2015 January | 84 | 5 | 89 |
| 2014 December | 94 | 9 | 103 |
| 2014 November | 110 | 9 | 119 |
| 2014 October | 94 | 14 | 108 |
| 2014 September | 85 | 12 | 97 |
| 2014 August | 93 | 12 | 105 |
| 2014 July | 96 | 9 | 105 |
| 2014 June | 150 | 12 | 162 |
| 2014 May | 116 | 10 | 126 |
| 2014 April | 134 | 5 | 139 |
| 2014 March | 97 | 15 | 112 |
| 2014 February | 111 | 12 | 123 |
| 2014 January | 86 | 8 | 94 |
| 2013 December | 69 | 10 | 79 |
| 2013 November | 70 | 5 | 75 |
| 2013 October | 59 | 9 | 68 |
| 2013 September | 74 | 13 | 87 |
| 2013 August | 70 | 14 | 84 |
| 2013 July | 77 | 13 | 90 |
| 2013 June | 45 | 10 | 55 |
| 2013 May | 51 | 7 | 58 |
| 2013 April | 32 | 5 | 37 |
| 2013 March | 15 | 1 | 16 |
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