Peak%20flow%20metery

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Peak flow metery
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Topics

• Definition
• Indications
• Steps
• Interpretation
• Serial PEFR
• Types
• Maitenance

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references

• AAAAI
• THORAX Journal
• American lung association
• European Respiratory Journal
• Caremark Journal
• European J of allergy clinical immunology
• Rom ladou textbooks

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What is a peak flow meter?

• Portable, inexpensive, hand-held device used to
  measure how air flows from lungs in one "fast
  blast (PEFR).
• A peak flow meter for asthma is like a
  thermometer for a fever.
• Reflects the degree of airway obstruction
• Liters/min

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Who needs a peak flow meter?

• Adults and children (over 5 years of age) who
  require medication for asthma on a daily or
  near-daily basis

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• Determine the severity of your asthma
• Evaluate the effectiveness of your current
  treatment
• Determine when to add or stop certain medications
  
• Recognize an asthma attack before signs or
  symptoms appear
• Decide when to seek emergency care

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indication

• Management
• Determine the severity of asthma.
• response to treatment during an acute asthma
  episode.
• monitor progress in treatment of chronic asthma
• detect worsening in lung function
• COPD
• Dx
• asthma
• ?gt20 in PEFR following administration of a
  bronchodilator.
• Diurnal variation gt20
• ?Document the work-relatedness of asthma
• Exercise induced asthma
• Nocturnal asthma(?gt15 from the previous)
• Epidemiologic investigation

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• You will see a drop in peak flow readings even
  before the symptoms of asthma (like coughing or
  wheezing) get worse.
• Decreases in peak flow may indicate that you
  need to increase your medication.
• The peak flow value can give the physician a
  better idea of how the patient are responding to
  treatment at home.

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HOW TO USE A PEAK FLOW METER?

• STEPS

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• Make sure the device reads zero or is at base
  level

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• Stand up straight. (unless handicapped, in which
  case the position should be the same for all
  maneuvers)
• Nose clips are unnecessary
• Take a deep breath as far as possible

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• Place the meter in your mouth and close lips
  around it.
• Do not put your tongue inside the hole

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• Blow out as hard and as fast as possible (one to
  two seconds)
• Do not cough or let the tongue block the
  mouthpiece

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• Write down the value obtained
• Move the marker back to the bottom, and repeat
  these steps two more times.
• If you cough or make a mistake, do not include
  this as one of your three tries.
• Record the highest of the three numbers in your
  chart.

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• Check which zone corresponds with your highest
  score.
• Follow the plan developed by you and your doctor
  for the appropriate zone

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• Measure your PFR close to the same time each day
  
• Twice daily between 7-9 a.m 6-8 p.m
• Keep a chart of your PFRs

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What will my readings tell me?

• When asthma is well controlled, there should be
  very little difference between the day-to-day
  readings or between the morning and evening
  readings.
• The main clue to uncontrolled asthma is readings
  that change a lot from day-to-day or between
  morning and evening.

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What is a normal peak flow rate?

• predicted "normal" peak flow is determined by
  height, age, sex and race.
• it is preferable to gauge asthma control by
  comparing daily peak flow recordings with
  "personal best" reading.

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• it is difficult to say exactly what a person's
  best peak flow should be. For example you can
  expect
• M ,25yr, 1.85m ? 627 L/min
• F ,40yr,1.57m ? 427 L/min
• child ,6-15yr,1.40m? 254 L/min

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Personal best

• Is the highest peak flow number a patient can
  achieve over a 2-3 week period when his or her
  asthma is under good control.
• Personal best values will change as child. grow
  taller and as disease status changes?periodically
  readjust personal best.
• To determine personal best
• Always use the same peak flow meter
• Record peak flow twice a day for two weeks
• Ignore outlying values

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How can the patient determine a normal PFR ?

• 3 zones of measurement are commonly used to
  interpret PFRs
• It is easy to relate the 3 zones to the traffic
  light colors green, yellow, red.
• A normal PFR can vary as much as 20

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Green zone

• PEFR 80-100 of your personal best
• Your breathing is good.
• You do not have any early warning signs or
  asthma symptoms.
• Take all your medicines every day, as your doctor
  tells you.
• Take your inhaler before exercise, as your doctor
  tells you.

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Yellow zone

• PEFR 60-80 of your personal best
• Caution
• Use "rescue" medicine
• Recheck peak flow after 20-30 min.
• Call your doctor if
• your peak flow is not back up to the Green Zone
• if you continue to need rescue medicine in less
  than 4 h.

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Red zone

• PEFR lt60 of your personal best
• Danger
• Use your quick-relief medicine by inhaler or
  nebulizer right away!
• Call your doctor or115

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traffic light zonal system
guide to aid patients in asthma management.
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• Your peak flow meter is only an aide to you. Do
  not rely on your peak flow numbers alone when
  deciding whether to take your rescue medicine or
  call your doctor. Your symptoms also need to be
  considered.

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What are some signs that my asthma is getting
worse?

• Early warning signs of an asthma attack
• Runny, stuffy nose
• Fatigue
• Chin or throat itches
• Headache
• Moodiness
• Cough with activity or laughing
• Wheezing with activity
• Waking up at night or early morning with a cough
  or wheeze
• Faster breathing rate
• Irritability

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Sample chart
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Serial PEFR

• Is often the best way to document the work-
  relatedness of asthma.
• at least 4 times daily over 2 weeks
• 4 weeks with 2 hourly measurements.
• The time of "Waking Up", "Starting Work", "Ending
  Work" and "Going To Bed on each day plus at time
  of acute chest tightness
• Always done before medication
• Record daily responses as (yes/no) exposure,
  tight chest, respiratory infection also, use of
  inhaled bronchodilator (number of times).

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• gt20 diurnal variability in PEFR is considered
  evidence of an asthmatic response.
• The major advantage detect late responses that
  occur after the work ends.

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Recommended approach

• Serial PEFR for 2-3 weeks at work at least 10
  days off work.
• Recording every 2 h

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Positive test(work relatedness)

• A consistent pattern of a change in PEFR which is
  greater than 25at work
• Increased daily variability should be associated
  with PEFR deterioration.
• deterioration in PEFR in work week
• improvement in non-work periods.

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• mean

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What are the differences between meters?

• There are 3 things to consider
• Brand
•  Mini-Wright peak flow meters
• EN 13826
• Scale
• Wright/ATS/EU
• Range
• low range? small child.
• standard range? older child, teen, adult.

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mechanical
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electronic
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•                                                 
                                                    
                                                    
                                                    
                                                    
                                                    
                                                    
    

• The Original Wright Peak Flow Meter - Standard
  and Low Range versions

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The Mini Wright Peak Flow Meter - Standard and
Low Range versions (from left to right Wright
scale, EU scale, ATS scale)

•                                                 
                                                    
                                                    
                                                    
                                                    
                                                    
                                                    
    

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•                                                 
                                                    
                                                    
                                                    
                                                    
                                                    
                                                    
    

• Other designs of peak flow meters are available

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Cleaning

• Remove the mouthpiece
• Rinse it with warm water
• Run warm water through the entire meter
• Let the meter air-dry on a clean paper towel
• Never boil, heat or clean the meter in the
  dishwasher

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Thanks for your attention
Atena farjamy
86.7.17