title: Evaluation of flow limitation in elderly patients unable to perform a forced expiratory maneuver.
abstract: OBJECTIVE
  The assessment of pulmonary function in elderly persons is not often easy in the clinical practice because of poor patient collaboration. A new technique, negative expiratory pressure (NEP), should provide a simple, rapid and non-invasive method for detecting flow limitation without collaboration of the patients. Our aim was to investigate whether it is possible to detect an expiratory flow limitation during resting breathing with NEP in elderly patients unable to perform a forced expiratory maneuver.
  
  
  METHODS
  In 15 elderly inpatients (4 males and 11 females, mean age 83+/-4.7 SD years) unable to realize the classical forced expiratory maneuver because of poor coordination or cognitive disturbance, we applied the NEP technique during spontaneous breathing.
  
  
  RESULTS
  NEP application during resting breathing was easily and rapidly performed in all cases without side effects. During NEP (-5cmH2O and NEP -10cmH2O), 6 and 5/15 patients were flow limited; mean flow limitation was 60+/-9% and 70+/-15% respectively. These results were reproducible with repeated NEP tests.
  
  
  CONCLUSIONS
  Application of negative pressure at the mouth during tidal expiration provides a simple method for detecting expiratory flow limitation during spontaneous breathing in elderly patients with poor collaboration.
authors.affiliation: Emergency Unit, Université Catholique de Louvain, Yvoir, Belgium. Dominique.Vanpee@rean.ucl.ac.be
authors.forename: Dominique
authors.initials: D
authors.lastname: Vanpee
authors.forename: Christian
authors.initials: C
authors.lastname: Swine
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Delwiche
authors.forename: Luc
authors.initials: L
authors.lastname: Delaunois
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000150:complications; D005260:Female; D005540:Forced Expiratory Flow Rates; D006801:Humans; D008171:Lung Diseases / Q000150:complications / Q000175:diagnosis*; D008297:Male; D010349:Patient Compliance; D012129:Respiratory Function Tests / Q000379:methods*