Single Breath Counting in the Assessment of Pulmonary Function,☆☆,

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Abstract

Study objectives: To assess the correlation of single breath counting (SBC) and peak expiratory flow rate (PEFR) to forced expiratory volume in the first second (FEV1 Design: Prospective comparison of pulmonary function measurements. Setting: University hospital pulmonary function test (PFT) laboratory. Type of participants: Consenting patients scheduled to have PFTs May 1, 1992, through November 1, 1992. Interventions: SBC was measured by asking patients to take a deep breath and count as far as possible in their normal speaking voice without taking another breath. Counting was timed to a metronome set at 2 counts per second. A hand-held peak flowmeter was then used to measure PEFR. Standard PFTs then were performed. Measurements and main results: Twenty-two patients were enrolled. The correlation of SBC to FEV1 (r=.68) was slightly better than of PEFR to FEV1 (r=.63). SBC was also found to correlate well with PEFR (r=.68). Conclusion: SBC is a reasonable alternative to PEFR. Further investigation in an emergency department setting is warranted.

[Bartfield JM, Ushkow BS, Rosen JM, Dylong K: Single breath counting in the assessment of pulmonary function. Ann Emerg Med August 1994;24:256-259.]

Section snippets

INTRODUCTION

Bronchospastic disease is frequently encountered in the emergency department. Forced expiratory volume in the first second (FEV1) is the best parameter to measure its severity and response to treatment.1 The need for expensive spirometry equipment and a skilled operator limits its availability in emergency practice. The most commonly used alternative test is the peak expiratory flow rate (PEFR). PEFR is usually easy to obtain using an inexpensive hand-held meter. In our experience, inability of

MATERIALS AND METHODS

The study was approved by our institution's Committee on Research Involving Human Subjects. Any adult (18 years of age or older) scheduled for routine pulmonary function testing from May 1, 1992, through November 1, 1992, was eligible to participate. Potential subjects therefore had a wide variety of diagnoses and were not being treated for acute exacerbation of bronchospasm at the time the study was performed. After obtaining informed consent and before undergoing regularly scheduled pulmonary

RESULTS

Twenty-four patients were enrolled; however, two (8%; 95% confidence interval, 1% to 27%) had to be eliminated because SBC values did not agree to within 10%, leaving 22 patients available for analysis. It took three attempts to obtain three SBC and PEFR scores to agree to within 10% in all except one of the 22 study patients. The remaining patient required four attempts to obtain three scores that were within 10% of one another as dictated by the study protocol.

Twelve (55%) of the 22 study

DISCUSSION

Measurement of FEV1 and PEFR have been shown to be useful in the assessment of acute asthma.2, 3 In a recent study by Bollinger et al in which both parameters were measured using a pneumotachograph, PEFR was found to be a better predictor for the need for hospitalization.4 To a large extent, in the ED setting, formal spirometry using pneumotachographs have been replaced by hand-held peak flowmeters that measure PEFR. A previous ED study comparing PEFR measured by a mini-Wright peak flowmeter

CONCLUSION

When performed by a certified pulmonary function technician in a pulmonary function laboratory, on patients without acute exacerbations of bronchospasm, SBC is a reasonable alternative measure of airways function compared with PEFR. SBC is simple to perform and requires only a simple timing device. Further investigation in an ED setting is warranted.

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From the Department of Emergency Medicine* and the Department of Internal Medicine, Albany Medical College, New York.

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Address for reprints: Joel M Bartfield, MD, Department of Emergency Medicine, Albany Medical College, 47 New Scotland Avenue, Albany, New York 12208, 518-262-3773, Fax 518-262-3236

Reprint no. 47/1/56938

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