• R Perez-Padilla, W M Vollmer, J C Vázquez-García, P L Enright, A M B Menezes, A S Buist, and BOLD and PLATINO Study Groups.
• Instituto Nacional de Enfermedades Respiratorias, Mexico DF, Mexico. perezpad@servidor.unam.mx
• Int. J. Tuberc. Lung Dis. 2009 Mar 1; 13 (3): 387-93.

BackgroundChronic obstructive pulmonary disease (COPD) is underdiagnosed. One barrier to diagnosis is the limited availability of spirometry testing, but in adults at risk for COPD, a normal pre-bronchodilator (pre-BD) peak expiratory flow (PEF) may rule out clinically significant COPD.ObjectiveTo identify post-BD airway obstruction using data from 13 708 individuals aged >or=40 years from the PLATINO and BOLD studies.MethodsWe evaluated different cut-off points of pre-BD. The PEF was obtained from a diagnostic-quality spirometer (not a mechanical PEF meter). At least one of the following COPD risk factors was present in 77% of the subjects: chronic respiratory symptoms; exposure to tobacco smoke, biomass smoke or dust in the workplace; or a previous diagnosis of asthma, COPD, emphysema or chronic bronchitis.ResultsAlthough the positive predictive value was low as expected, a pre-BD PEF of >or=70% predicted effectively ruled out Stages III and IV COPD of the Global Initiative for Chronic Obstructive Lung Disease. Among those with at least one risk factor, only 12% would require confirmatory spirometry using this criterion.ConclusionsAdding PEF measurement to a screening questionnaire may rule out severe to very severe COPD without the need for pre- and post-BD spirometry testing. Confirmation is needed from a study using inexpensive PEF meters or pocket spirometers with a staged screening protocol.

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