PEAK FLOW METER

A peak flow meter is a mechanical device in which the patient blows out. The force of
the expiration pushes an indicator. The device
measures air flowing out of the lungs, called peak
expiratory flow rate (PEFR). Peak expiratory flow rate
(PEFR) is the maximum flow rate generated during a
forceful exhalation, starting from full lung inflation.
Peak flow rate primarily reflects large airway flow and
depends on the voluntary effort and muscular strength
of the patient.
Maximal airflow occurs during the effort-dependent portion of the expiratory
maneuver, so low values may be caused by a less than maximal effort rather than by airway
obstruction. Nevertheless, the ease of measuring peak flow rate with an inexpensive small
portable device has made it popular as a means of following the degree of airway obstruction
in patients with asthma and other pulmonary conditions.
A peak flow meter, when used properly, can reveal narrowing of the airways well in advance
of an asthma attack. Used mainly by persons with moderate to severe and persistent asthma,
peak flow meters can help determine:
when to seek emergency medical care.
the effectiveness of a person's asthma management and treatment plan.
when to stop or add medication, as directed by your physician.
what triggers the asthma attack (such as exercise-induced asthma).
Measuring Peak Expiratory Flow
Peak flow meters should be used regularly to check how well the asthma is being controlled.
In addition, the peak flow meter may be a valuable tool during an asthma attack, because it
can help determine how well the short-term, quick-relief asthma medication is working. The
National Heart, Lung, and Blood Institute (NHLBI) recommends measuring lung function
during the following times:
every morning, before taking asthma
medications
during asthma symptoms or an asthma
attack
after taking medication for an asthma attack
other times recommended by your physician
During a peak flow measurement the patient needs to sit up straight or stand up.
The patient inspires as deeply as possible, takes the device in his mouth and blows out as
strongly and as fast as he can. It is not necessary to blow out as long as possible, in contrast to
a spirometry test. An expiration of 1 second is sufficient.
The test is repeated at least three times and the best value is withheld.
Peak flow is comared to predicted values or - even better - to the patient's best personal value.
Predicted values are dependant of sex, age, height and ethnicity. Measured peak flow meters
are classified in the peak flow zones.
Peak flow zones are based on the traffic light concept: red means danger, yellow means
caution, and green means safe. Based on your personal best peak flow measurement (the
optimal level of your lung function), your three peak flow zones include:
Green: 80 to 100 percent of your personal best peak flow measurement; asthma is
under control.
Yellow: 50 to 79 percent of your personal best peak flow measurement; asthma is
getting worse; you may need to use quick-relief medications or other medication, as
directed by your physician.
Red: below 50 percent of your personal best peak flow measurement; medical alert,
take quick-relief medication and seek medical help immediately.
The goal of the peak flow zones is to help you recognize when the asthma may start to
become uncontrolled. The goal is to stay within the 80 percent value of your personal best
peak flow measurement. Zones with a smaller range, such as 90 to 100 percent, may be
recommended by some health care providers. Always follow the advice of your doctor
regarding the peak flow rate.
Limitation of Peak Expiratory Flow Measurement
Peak flow measurement is a simple and cheap test, but there are important limitations
to measuring peak expiratory flow.
A peak flow measurement measures per definition only one parameter. The peak flow
is a parameter that can vary significantly and is very effort dependant.
Peak flow measurement historically is used for diagnosis and follow-up of asthma. For this
measurement of peak flow is an acceptable - but limited - method, if different measurements
at different time intervals can be done. Because of the natural varation of the peak expiratory
flow, an isolated measurement has limited value.
Peak flow measurement is often used in diagnosis and follow-up of COPD as well. However,
peak flow measurement is not an adequate means of diagnosis or follow-up for this
pathology. Often in COPD peak flow is only affected in moderate or severe cases. The other
lung function parameters can be so low at this point that the patient is experiencing
respiratory symptoms. COPD is a disease that needs to be detected and treated as early as
possible.













The GOLD guidelines for COPD do not take into account peak expiratory flow for
judging the severity of COPD.
The forced expiratory volume after 1 second (FEV1) and the Tiffeneau index (FEV1/VC%)
are far better parameters to judge COPD severity.

Two obstructive F/V
loops are shown.
Although the black
loop is showing clear
signs of obstruction,
PEF is normal.
The red loop is a
GOLD class I COPD
patient, but still shows
a PEF of approx. 75%
of normal value