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We aimed to use the administration of salbutamol after a methacholine challenge test as a model of bronchodilation to study how accurately the change in PEF predicts improvement in lung function, as defined by an increase in FEV\n                    <jats:sub>1<\/jats:sub>\n                    . We analyzed 869 adult patients who were administered salbutamol after a methacholine challenge. To compare relative changes in PEF and FEV\n                    <jats:sub>1<\/jats:sub>\n                    during bronchodilation, we used regression analysis and constructed a Bland and Altman plot. ROC analysis, sensitivity, specificity, positive and negative predictive values, and kappa coefficient assessed how precisely increases in PEF detected a 12% and 0.2\u2010L improvement in FEV\n                    <jats:sub>1<\/jats:sub>\n                    . The average relative increase in FEV\n                    <jats:sub>1<\/jats:sub>\n                    was significantly greater than that in PEF. The area under the curve in the ROC analysis was 0.844 for PEF change to detect a 12% and 0.2\u2010L increase in FEV\n                    <jats:sub>1<\/jats:sub>\n                    . The kappa values for changes in PEF and FEV\n                    <jats:sub>1<\/jats:sub>\n                    ranged from fair to moderate. BDR detected by the recommended 15% and 60\u2009L\/min cut\u2010off for PEF identified less than half of true positives, while a 10% cut\u2010off correctly identified close to 75% of them. PEF increase is not a reliable measure of BDR in comparison to FEV\n                    <jats:sub>1<\/jats:sub>\n                    increase, and a 10% improvement in PEF was the least inaccurate cut\u2010off. Substituting the PEF meter with a handheld spirometer should be further investigated for asthma home monitoring.\n                  <\/jats:p>","DOI":"10.1155\/pm\/7675935","type":"journal-article","created":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T02:33:58Z","timestamp":1751942038000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Relation of Changes in PEF and FEV\n                    <sub>1<\/sub>\n                    During Salbutamol\u2010Induced Bronchodilation After Methacholine Challenge Test"],"prefix":"10.1155","volume":"2025","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-0215-0805","authenticated-orcid":false,"given":"Leon 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