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Peak Form

Each page on this chart holds 8 weeks of peak flow readings. Take a deep breath, seal your mouth tightly around the mouthpiece, then blow as hard and as fast as you can. Each square up the chart represents 10 on your peak flow meter. Each night, use the box at the bottom to record the total number of puffs of reliever medication (e.g. Ventolin) which you used in the last 24 hours.

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Yugesh Yugi
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© Attribution Non-Commercial (BY-NC)
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101 views3 pages

Peak Form

Each page on this chart holds 8 weeks of peak flow readings. Take a deep breath, seal your mouth tightly around the mouthpiece, then blow as hard and as fast as you can. Each square up the chart represents 10 on your peak flow meter. Each night, use the box at the bottom to record the total number of puffs of reliever medication (e.g. Ventolin) which you used in the last 24 hours.

Uploaded by

Yugesh Yugi
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Peak Flow Chart

Patient Name: Doctor Name: Doctor Telephone:

1. Write the start date at the top of each page. Each page on this chart holds 8 weeks of peak flow readings. 2. For each day (e.g. Su for Sunday), there is a white column for your morning peak flow and a grey column for your evening peak flow. 3. Each morning and evening, record the highest of three peak flows. Take a deep breath, seal your mouth tightly around the mouthpiece, then blow as hard and as fast as you can. Check the number, re-set the pointer to zero, and repeat two more times. 4. Use a black pen to record the highest of the 3 peak flows on the chart see example. Each square up the chart represents 10 on your peak flow meter. 5. Each night, use the box at the bottom to record the total number of puffs of reliever medication (e.g. Ventolin) which you used in the last 24 hours. Notes: If you miss measuring your peak flow, dont make up a number, just leave a gap. Talk to your doctor or asthma nurse if you are having trouble recording your peak flow. Always take the chart with you when you visit your doctor. Even if you dont normally record your peak flow, doing 2 weeks of readings before a visit may be helpful. Use arrows on the chart to show where your medication changed, or you had a cold. Remember to use the treatment on your Asthma Action Plan if your asthma gets worse or your peak flow falls below your action point.

Woolcock Insitute of Medical Research PO Box M77, Missenden Road NSW 2050 Australia www.woolcock.org.au
2006 Woolcock Insitute of Medical Research

T + 61 2 9515 8710 F + 61 2 9550 5865 E admin@woolcock.org.au

Bagan Specialist Centre Sdn . Bhd. PEAKFLOW CHART

750 700

70 0

70 0

70 0

70 0

70 0

70 0

70 0

70 0 65 0 60 0 55 0 50 0 45 0 40 0 35 0 30 0

650

65 0

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600

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550

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500

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450

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400

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350

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300

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250

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25 0 20 0 15 0 10 0 50

200

20 0

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150

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100

10 0

10 0

10 0

10 0

10 0

10 0

10 0

50 0 (puffs/day) Reli ever

50

50

50

50

50

50

50

NAME RN ______________________ _____________________

: _____________________ : SEX/AGE :

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