Does negative expiratory pressure (NEP) during spontaneous breathing predict respiratory impairment in elderly?

Objective: The purpose of this study is to assess whether expiratory flow limitation (FL), as measured by applying a negative pressure at the mouth during tidal expiration, can evaluate the respiratory impairment in elderly patients. Methods: The study was carried out in 67 consecutive elderly inpat...

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Bibliographic Details
Published in:Respiratory medicine 2005, Vol.99 (1), p.66-69
Main Authors: Vanpee, D., Delwiche, J.P., Swine, C., Jamart, J., Delaunois, L.
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Airways obstruction
Anthropometry
Biological and medical sciences
Chronic obstructive pulmonary disease, asthma
Dyspnea
Dyspnea - diagnosis
Dyspnea - etiology
Dyspnea - physiopathology
Elderly
Epidemiologic Methods
Exhalation
Female
Forced Expiratory Volume
Humans
Male
Medical sciences
Negative expiratory pressure
Pneumology
Pulmonary Ventilation
Respiratory system : syndromes and miscellaneous diseases
Spirometry
Vital Capacity
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Summary:Objective: The purpose of this study is to assess whether expiratory flow limitation (FL), as measured by applying a negative pressure at the mouth during tidal expiration, can evaluate the respiratory impairment in elderly patients. Methods: The study was carried out in 67 consecutive elderly inpatients (24 men and 43 women). Negative expiratory pressure (NEP) of –5 (NEP 5) and –10 (NEP 10) cm H 2O were applied during spontaneous tidal expiration. According to the results of the NEP technique, the patients were stratified in two categories: not flow limited and flow limited. We realized then classic forced expiratory manœuvres (FEV 1, FVC) and clinical evaluation of dyspnea (NYHA). According to the values of the lung function data, elderly patients were then divided in 3 groups (normal, obstructive, restrictive). Results: The sensitivity, the specificity, the positive and negative predictive values for the diagnosis of obstructive syndrome by the presence of flow limitation during NEP 5 were 53, 74, 45, 79% respectively and 58, 83, 58, 83% respectively during NEP 10. These findings show that the correlation between FL obtained by the NEP technique during spontaneous breathing and spirometry is not very good despite the fact that both were well correlated with dyspnea score. Conclusions: In clinical practice, faced with an elderly dyspneic patient unable to perform maximal expiratory manoeuvres, the evaluation of flow limitation by NEP technique seems nor to be reliable to predict an obstructive functional impairment nor to be able to explain the origin of his dyspnea.
ISSN:0954-6111
1532-3064
DOI:10.1016/j.rmed.2004.05.011