A Systematic Review of Serial Peak Expiratory Flow Measurements in the Diagnosis of Occupational Asthma

Moore V, Jaakkola M, Burge PS. A Systematic Review Of Serial Peak Expiratory Flow Measurements In The Diagnosis Of Occupational Asthma.  Annals of Respiratory Medicine, February 2010; 1(1):31-44

Review Article

Vicky C Moore ¹, Maritta S Jaakkola ^{2 3}  and P Sherwood Burge ¹

Affiliations: ¹Occupational Lung Disease Unit, Birmingham Heartlands Hospital, Birmingham, UK; ²Respiratory Medicine Unit, Department of Internal Medicine, Institute of Clinical Medicine, University of Oulu, Oulu, Finland and ³Institute of Occupational and Environmental Medicine, University of Birmingham, Birmingham, UK

ABSTRACT

This paper systematically reviews literature on the application of serial peak expiratory flow (PEF) measurements in the diagnosis of occupational asthma and calculates summary estimates of the sensitivity, specificity, and feasibility of serial PEFs.

Methods
Papers were searched for on the Medline database via the PubMed website (http://www.ncbi.nlm.nih.gov/sites/entrez) and on the Birmingham Chest Clinic departmental website www.occupationalasthma.com from 2004 until April 2009 using the search terms “Peak flow AND occupational asthma” and “Peak flow AND work related asthma”. Abstracts were screened to select those justifying a full paper review. Papers used in the British Occupational Health Research Foundation (BOHRF) guidelines (current until June 2004) were also reviewed. Case studies and narrative reviews were excluded. Type of analysis, quality of paper, sensitivity, and specificity of serial PEFs compared with reference tests and return rates were documented. Results were pooled from all studies to produce overall estimates.

Results
A total of 80 abstracts were reviewed, leading to 23 full papers for further review plus 15 papers from the 2004 BOHRF review. Seven papers were excluded (mostly for duplicate data), leaving 31 papers for inclusion. The pooled sensitivity of serial PEF fulfilling minimum data quantity requirements for a diagnosis of occupational asthma was 82% (95% CI 76–90%), and the pooled specificity was 88% (95% CI 80–95%). Return rates were similar between PEFs requested through workplace studies (85%) and those requested in a clinical setting (78%), with 61% being interpretable for a diagnosis of occupational asthma from either setting.

Conclusion
Based on a systematic literature search, serial PEF measurement is a feasible, sensitive, and specific test for the diagnosis of occupational asthma, when potential sources of error are understood.

Keywords: occupational asthma, peak expiratory flow, sensitivity, specificity, return rate, adequate data quantity
Correspondence: Vicky Moore, Occupational Lung Disease Unit, Department of Respiratory Medicine, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS, UK. Tel: (44)‐121‐424‐2745; Fax: (44)‐121‐772‐4259; e‐mail: vicky.c.moore@heartofengland.nhs.uk