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(Chest. 2001;120:1861-1868.)
© 2001 American College of Chest Physicians

Correlates of Peak Expiratory Flow Lability in Elderly Persons*

Paul L. Enright, MD; Robyn L. McClelland, MS; A. Sonia Buist, MD and Michael D. Lebowitz, PhD; for the Cardiovascular Health Study Research Group{dagger}

* From the College of Public Health (Drs. Enright and Lebowitz), University of Arizona, Tuscon, AZ; the Department of Biostatistics and Epidemiology (Ms. McClelland), the Mayo Clinic, Rochester, NY; and the Department of Pulmonary and Critical Care Medicine (Dr. Buist), Oregon Health Sciences University, Portland, OR. {dagger} A list of participants is shown in the Appendix.

Correspondence to: Paul L. Enright, MD, The University of Arizona, 1501 North Campbell Ave, Tucson, AZ 85724; e-mail: lungguy{at}aol.com

Objective: To determine the correlates of the lability of peak expiratory flow (PEF) in the elderly.

Methods: A community sample of 4,581 persons >= 65 years old from the Cardiovascular Health Study completed an asthma questionnaire and underwent spirometry. During a follow-up examination of the cohort, 1,836 persons agreed to measure PEF at home twice daily for 2 weeks, and 90% successfully obtained at least 4 days of valid measurements. PEF lability was calculated as the highest daily (PEF maximum - PEF minimum)/mean PEF.

Results: Mean PEF measured at home was accurate when compared to PEF determined by spirometry in the clinic. Mean PEF lability was 18% in those with current asthma (n = 165) vs 12% in healthy nonsmokers (upper limit of normal, 29%). Approximately 26% of those with asthma and 14% of the other participants had abnormally high PEF lability (> 29%). After excluding participants with asthma, other independent predictors of high PEF lability included black race, current and former smoking, airway obstruction on spirometry, daytime sleepiness, recent wheezing, chronic cough, emphysema, and wheezing from lying in a supine position. Despite having a lower mean PEF, those reporting congestive heart failure (n = 82) did not have significantly higher PEF lability.

Conclusions: Measurement of PEF lability at home is highly successful in elderly persons. PEF lability >= 30% is abnormal in the elderly and is associated with asthma.

Key Words: airway lability • asthma • elderly • peak expiratory flow




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