Abstract
Dyspneic patients are commonly encountered by Emergency Medical Service (EMS). Frequent causes include Chronic Obstructive Pulmonary Disease (COPD) and Congestive Heart Failure (CHF). Measurement of peak expiratory flow rate (PEFR) has been proposed to help differentiate COPD from CHF. This prospective, cohort, pilot study was conducted to determine if PEFR in patients with an exacerbation of COPD were significantly different than CHF. Included were patients presenting with dyspnea plus a history of COPD and/or CHF. A PEFR was measured, values were compared to predicted average, and a percentage was calculated. Twenty-one patients were enrolled. Six had a diagnosis of COPD, 12 CHF; 3 had other diagnoses. Mean percentage of predicted PEFR with COPD was 26.36%, CHF 48.9% (P = 0.04). Patients presenting with acute COPD had significantly lower percentage of predicted PEFR than those with CHF. These results suggest that PEFR may be useful in differentiating COPD from CHF. This study should be expanded to the prehospital setting with a larger number of subjects.
Highlights
Dyspnea, a common cause of Emergency Medical Service (EMS) calls, can result from problems involving many organ systems
Peak expiratory flow is not part of the standard protocol for gauging Congestive Heart Failure (CHF) patients, several studies have suggested that peak expiratory flow rate (PEFR) may be useful in helping to differentiate cardiac from pulmonary causes of dyspnea [3, 5]
The P value was calculated as 0.04 (Figure 1). Those with diagnoses of CHF or Chronic Obstructive Pulmonary Disease (COPD) were included in the data analysis (Table 1)
Summary
A common cause of Emergency Medical Service (EMS) calls, can result from problems involving many organ systems. Peak expiratory flow meters are small, inexpensive, and accessible devices used to measure the peak expiratory flow rate (PEFR) after maximal inspiration. They are commonly prescribed for asthma patients but have shown promise in assessing COPD [4, 5]. Peak expiratory flow is not part of the standard protocol for gauging CHF patients, several studies have suggested that PEFR may be useful in helping to differentiate cardiac from pulmonary causes of dyspnea [3, 5]. The purpose of this study is to determine if peak expiratory flow meters are effective in assisting EMS personnel in differentiating the respiratory and cardiovascular etiologies of dyspnea, and if so, to what extent. As an initial step in testing this hypothesis, the authors chose to perform a data collection in the ED to determine if use of the PEFR may be useful in the prehospital setting
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