[Variability in peak expiratory flow does not classify asthma according to severity].
OBJECTIVE
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.


METHODS
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: 1) difference between morning PEF and nighttime PEF, expressed as a percentage of the mean value of the PEF measurements taken on that day; 2) minimum PEF rate during a week, expressed as a percentage of the highest value recorded during that week; 3) difference between the highest and the lowest PEF values, expressed as a percentage of the highest value; and 4) 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.


RESULTS
The analysis of levels of agreement between clinical classification of asthma and formulas 1, 2, 3, and 4 gave quadratic weighted kappa 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).


CONCLUSIONS
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.
Pérez-Yarza
Eduardo G
EG
Unidad de Neumología, Servicio de Pediatría, Hospital Donostia, San Sebastián, Guipúzcoa, España. perezyar@chdo.osakidetza.net
Cobos
Nicolás
N
de la Cruz
Juan José
JJ
D001249:Asthma / Q000145:classification* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D010366:Peak Expiratory Flow Rate; D011446:Prospective Studies; D012720:Severity of Illness Index