Though the diagnosis of COPD is spirometry-based,2 it is worthwhi

Though the diagnosis of COPD is spirometry-based,2 it is worthwhile to note that there is no evidence to suggest that spirometry has an advantage over PEF in the day-to-day monitoring or management of patients with COPD,21 neither is it time efficient or easier to perform.22 As a result, PEF measurements, even without bronchodilation, could provide useful and readily accessible information to the general practitioner or primary care physicians www.selleckchem.com/products/chir-99021-ct99021-hcl.html about the daily or short-term structural changes in the airway and its effect on quality of life. We also observed that pre bronchodilator PEF predicts SGRQ quality of life score independent of age, sex,

height, smoking status or severity of COPD. However, PEF explains a small percentage of the variability in SGRQ scores and as such, there may be other parameters that also affect quality of life in COPD other than a simple measurement of the airflow status using a PEF meter. There is very sparse information on the utility of PEF assessment as an outcome measure in COPD. Hansen and colleagues showed that

PEF could be used to predict survival in patients with COPD.23 They compared the utility of FEV1 and PEF for assessing outcome in a sample of 1095 patients with COPD who were initially enrolled in the Copenhagen City Study.23 After a decade of follow up, they found the best PEF was at least equal to the best FEV1 as a predictor of overall mortality in subjects with COPD, after controlling for age, smoking, sex, and body mass index. They concluded that, “…. despite close correlation to FEV1, PEF provided independent prognostic information in selleck screening library patients with COPD”.23 The present study corroborates this finding and indicates that PEF may thus be invaluable in assessing the impact of COPD and for predicting its long-term outcome especially

in primary care centres. However, there is clearly a need for large sensitivity studies on this subject. Interestingly, for we also observed that sixty five percent of the patients in our study population had low lung function parameters (FEV1 & FVC) compared with predicted values using reference equations for African Americans. Forced vital capacity has been shown to correlate with survival.24 Populations with low forced vital capacity appear to suffer greater mortality however its determinants are poorly understood. Our population of patients was generally of the low socioeconomic class, a group known to have poor access to health care. It is unclear why our sample of patients had very low forced vital capacity and other lung parameters. This may probably be because the patients with COPD in our clinics appears quite late for treatment when they are already at advanced stages of the disease. Low lung function parameters may also suggest low maximally attained pre-morbid lung function and a subsequent rapid decline over time, a phenomenon described as ‘horse racing’.

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