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International Journal of Current Research in Physiology and Pharmacology
Review Articles
Submitted: 2019-07-07
Published: 2017-12-10

Effect of Cigarette Smoking on Peak Expiratory Flow Rate: A Short Review

Professor, Department of Physiology, DVVPFs Medical College, Ahmednagar, Maharashtra, India
Assistant Professor, Department of Physiology, DVVPFs Medical College, Ahmednagar, Maharashtra, India
Assistant Professor, Department of Physiology, DVVPFs Medical College, Ahmednagar, Maharashtra, India

Abstract

Tobacco smoking in India has been increasing alarmingly. Smoking is a known risk factor for chronic obstructive pulmonary disease (COPD), cardiovascular diseases and certain cancers, especially, lung cancer. Carbon monoxide from the smoke and nicotine both put a strain on the heart by making it work faster Peak expiratory flow rate (PEFR) is a simple index of pulmonary function and can be used in researchers, clinical practices and even under field conditions to assess the status of large airways. PEFR is decreased in cigarette smokers compared to non-smokers and the magnitude of the decline is higher in elderly individuals.

KEYWORDS: Peak expiratory flow rate; Smokers; Wrights peak flow meter

Smoking can cause various pathophysiological effects. It has been identified as the most important risk factor in Chronic Obstructive Pulmonary Disease (COPD)[1]. It significantly increases progressive deterioration of lung function. Pulmonary Function Test is a test to examine functional capacity of lungs and respiratory system. The common parameters measured in pulmonary function test are Peak Expiratory Flow Rate (PEFR) and Maximum Voluntary Ventilation (MVV).

Tobacco smoking is a major risk factor for cardiovascular disease, chronic obstructive pulmonary disease and some cancers and the morbidity and mortality with tobacco use is entirely preventable [2]. Smoking harms nearly every organ in the body, causing many diseases and reducing health in general. Further, a quarter of smokers develops chronic obstructive pulmonary disease [3] and is the fourth

commonest cause of death worldwide [4]. COPD is characterized by airflow limitation that is not fully reversible [5, 6]. Air flow limitation may be due to inflammation [5, 7] or due to increase in the thickness of the wall[8]. PEFR is a useful parameter to monitor airway obstruction, assess its severity and variation and evaluate the effects of treatment [9]. Earlier studies have reported that the PEFR is an effort dependent parameter emerging from large airways[10-12] and it does not detect small airways obstruction [13]. Further, there are inconsistent findings which showed that smoking affects medium and large airways [14, 15]. Others have reported that smoking affects both small and large airways [16, 17]. Several studies have reported that PEFR was significantly lower in smokers than in non-smokers [18-22]and some studies found maximum reduction in PEFR was in bidi smokers than cigarette smokers[23]. One possible reason for the decrease in PEFR could be inflammation which is common and constant pathological finding in cigarette smokers [24].

It has significant deleterious effects on respiratory tract. Smokers even if they are symptom free, have lower values of PEFR than non smokers. The diminution of PEFR runs more or less in parallel with the duration of smoking. Beedi smoking affects respiratory tract has significant deleterious effects on respiratory tract. Smokers even if they are symptom free, have lower values of PEFR than non smokers. Early detection of air flow obstruction and smoking cessation may result in significant health gain.

Figure 1. Normal Peak expiratory flow values in men and women

Zone Reading Description
Green Zone 80 to 100 percent of the usual or normal peak flow readings are clear. A peak flow reading in the green zone Indicates under good control
Yellow Zone 50 to 79 percent of the usual or normal peak flow readings Indicates caution. It may mean respiratory airways are narrowing and additional medication may be required.
Red Zone Less than 50 percent of the usual or normal peak flow readings Indicates a medical emergency. Severe airway narrowing may be occurring and immediate action needs to be taken. This would usually involve contacting a doctor or hospital.
Table 1. Indication zones

The highest of three readings is used as the recorded value of the Peak Expiratory Flow Rate. It may be plotted out on graph paper charts together with a record of symptoms or using peak flow charting software. This allows patients to self-monitor and pass information back to their doctor or nurse[25].

Peak flow readings are often classified into 3 zones of measurement according to the American Lung Association; green, yellow, and red. Doctors and health practitioners can develop an asthma management plan based on the green-yellow-red zones[26].

CONCLUSION

PEFR is decreased in cigarette smokers compared to non-smokers and the magnitude of decline is higher in elderly individuals. Smokers even if they are symptom free, have lower values of PEFR than nonsmokers.

Conflict of interest: Nil

Funding : Nil

REFERENCES

  1. Andrew Lumb, Nunn JF. Nunn’s applied respiratory physiology.  Elsevier Publishers. 4th edition;378-83
  2. Global Adult Tobacco Survey. GATS India 2009–10 Report. Ministry of Health & Family Welfare, Government of India, New Delhi, 2010.
  3. Van Schayck, CP, Loozen JM, Wagena E, Akkermans RP, Wesseling GJ. Detecting patients at a high risk of developing chronicobstructive pulmonary disease in general practice: cross sectional case finding study. BMJ 2002;.324:1370.
  4. Price D, Duerden, M. Chronic obstructive epulmonary disease. BMJ.2003;326:1046-07.
  5. Vesna Cukic, Vladimir Lovre, Dejan Dragisic, Aida Ustamujic. Asthma and Chronic Obstructive Pulmonary Disease (COPD) – Differences and Similarities. MaterSociomed. 2012; 24(2): 100–105.
  6. Dan LL, Dennis LK, Larry Jameson J, Anthony SF, Stephen Hauser, Joseph Loscalzo. Harrison’s Principles of Internal Medicine. McGraw- Hill Publications companies Inc. 2012; 18th ed.
  7. Vanhoutte PM. Airway epithelium andbronchial reactivity. Can J Physiol Pharmacol. 1987;65:448–50.
  8. Wright JL, Hobson J, Wiggs BR, Pare PD, Hogg JC. Effect of cigarette smoking onstructure of the small airways. Lung. 1987;165: 91–100.
  9. Quanjer PH, Lebowitz MD, Gregg I. Peak expiratory flow: conclusions andrecommendations of a Working Party of the European Respiratory Society. Eur Respir J 1997;Suppl.24: 2S–8S.
  10. American Thoracic Society. Standardization of Spirometry; update. AmerJ Respir Critical CareMed.1995; 152: 1107–36.
  11. Enright P, Linn WS, Edward L. Quality Spiromety test performance in children andadolescents: Experience in a large field study. Chest.2000;118: 665–71.
  12. Dikshit MB, Raje S, Agrawal MJ. Lung functions with spirometry: An Indian Perspective-I. Peak Expiratory Flow Rates. Indian J Physiol Pharmacol. 2005;49 (1): 8–18.
  13. Boskabady MH, Mahmoodinia M, Boskabady M, Heydar GR. Pulmonary function tests and respiratory symptoms among smokers in the city of Mashhad north east of Iran. Portugese Journal of Pulmonology. 2011;7: Number 5.
  14. Lange P, Groth S, Nyboe J, Morten J, Appleyard M, Jensen G. Effects of smokingand changes in smoking habits on the decline of FEV1. Eur Respir J.1989; 2:811-6
  15. Boskabady MH, Dehghani H, Esmaeilizadah M. Pulmonary function tests and theirreversibility in smokers. Tanafoos.2003; 2:23-30.
  16. Bajentri AL, Veeranna N. Effect of 2-5years of tobacco smoking on ventilator function test.Journal of Indian Med. Association.2003;101: 96-7, 108.
  17. Harpreet Kaur, Jagseer Singh, ManishaMakkar, Khushdeep Singh, Ruchika Garg. Variations in the Peak Expiratory Flow Rate with VariousFactors in a Population of Healthy Women of the Malwa Region of Punjab, India. Journal of Clinical and Diagnostic Research. 2013;7(6): 1000-03.
  18. Karia Ritesh. Comparative study of peak expiratory flow rate and maximum voluntary ventilation between smokers and non-smokers.National J Med Res. 2012;22: 191-3.
  19. Vaidya P, Kashayap S, Sarma A, Gupta D, Mohapatra PR. Respiratory symptoms and pulmonary function tests in school teachers of Shimla. Lung India. 2007; 24:6-10.
  20. Padmavathi KM. Comparative study of pulmonary function variables in relation to type ofsmoking. Indian J PhysiolPharmacol.2008;52 (2): 193–96.
  21. Mehmet Polatlý, Münevver Erdinç, Ertürk Erdinç. The Early Effect of Smoking on Spirometry and Transfer Factor. Turkish Respiratory Journal. 2000;1:31-34.
  22. Das KK, Dhundasi SA. A study on predictors of peak expiratory flow rate in muslim subjects (aged 18 to 20 years) of Karnataka. India J physiol pharmacol 2002;46(3): 321-327.
  23. Mead J, Tumer JM, Macklem PT, Little JB. Significance of the relationship between lung recoil and maximum expiratory flow. J Appl physiol 1967;22:95-108.
  24. Ebomoyi MI, Iyawe VI. Variations of peak expiratory flow rate with anthropometric determinants in a population of Healthy adult Nigerians. Niqerian Journal of physiological science 2005;20(1-2): 85-89.
  25. Scottish Intercollegiate Guidelines Network; The British Thoracic Society. British Guideline on the Management of Asthma - Annex 8: Personal Asthma Action Plan. Thorax. 2007;58 (Suppl I).
  26. American Lung Association. How can I determine a normal peak flow rate for me. Available at: http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/asthma/living-with-asthma/managing-asthma/measuring-your-peak-flow-rate.html? Assessed on 12/07/2017 at 10.00pm

How to Cite

Nighute, S., Buge, K., & Kumar, S. (2017). Effect of Cigarette Smoking on Peak Expiratory Flow Rate: A Short Review. International Journal of Current Research in Physiology and Pharmacology, 1(1), 3–5. Retrieved from https://ijcrpp.com/index.php/ijcrpp/article/view/19