Citation:

Quackenboss, J., M. Lebowitz, AND M. Krzyanowksi. NORMAL OF RANGE OF DIURNAL CHANGES IN PEAK EXPIRATORY FLOW RATES. U.S. Environmental Protection Agency, Washington, D.C., EPA/600/J-91/167.

Description:

Measuring peak expiratory flow rates (PEFR) several times a day can provide an objective assessment of functional changes relative to environmental or occupational exposures. his report describes the pattern of diurnal changes in PEFR in a reference population, and defines ranges of "normal" between-and within-day variability. n index of diurnal changes were defined as the ratio between maximal and minimal values, where the maximal value was restricted to PEFR measured at noon or in the evening (N,E) and the minimal value was restricted to the morning or at bedtime (M,B). atio greater than normal represented an exaggeration of the normal diurnal pattern in PEFR. ormal limits, based on the ninety-fifth percentile in the reference population, were larger for children (130%) than for adults 15 to 35 yr of age (117%) and those older than 35 yr of age (118%). he meaningfulness of excessive diurnal changes in PEFR was examined by relating this ratio (Max/Min), and a similar measure (the amplitude percent mean) to chronic respiratory symptoms and diseases in 939 adults and children who recorded PEFR values 2 to 4 times per day for as long as 14 days. here was a strong relationship of diurnal changes in PEFR that exceed normal limits with physician-confirmed asthma (relative risk of 2.99 with Max/Min), with exertional dyspnea (Grade 2+), and with more frequent reporting of acute symptoms of wheeze, attacks of wheezing dyspnea, cough, and chest colds. n addition, those exceeding the normal limits had about 2.9 times greater risk of having FEV, below 80% of predicted, and nearly 7 times greater risk of being below 70%. hese associations support the interpretation of excessive diurnal changes in PEFR as an indicator of bronchial responsiveness.

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