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Do not further stress patients who are severely short of breath or who are hemodynamically unstable by having them use a peak flowmeter. Do not attempt a peak expiratory flow measurement with patients who have had recent eye surgery after which straining is contraindicated.
Most children age 5 or olderundefined#ref3">3 are capable of using a peak flowmeter (Figure 1) as part of their asthma management plan. Use a low-range peak flowmeter for small children (typically 8 years old or younger) and use a standard-range peak flowmeter for older children, teenagers, and adults.2
Anticipate predicted values for peak expiratory flow rate (PEFR) (Table 1) to be approximately 10% lower for black and Hispanic patients than those shown in predicted peak flow tables.5
In children experiencing acute asthma exacerbations, PEFR correlates poorly with clinical appearance.1
Peak expiratory flow measurement is also known as peak flow or PEFR. PEFR is the maximal flow rate that a person can achieve during a short maximal expiratory effort, following a full inspiration.3,4
Increased bronchospasm or narrowing of the airways results in a decreased speed of air flow. PEFR measurement is used to assess respiratory function in obstructive airway diseases (especially asthma) and to evaluate the patient’s response to bronchodilator therapy. Peak flow is the most commonly used objective value that can be assessed at the bedside or at home; a declining value indicates the patient’s condition is deteriorating or not responding to therapy. Three PEFR measurements are obtained and only the highest is recorded.3
Ideally, peak expiratory flow should be measured before and after nebulizer treatments. The practitioner decides which scale meter to use in measuring PEFR; most commonly used are the European Union (EU) scale meter and the Wright scale meter. In addition, electronic peak flowmeters are available and can automatically record and track PEFR.
If exhaled air leaks through the nose, use a nose clip or have the patient pinch his or her nose closed, because any leakage of air will yield an inaccurate reading.
Gorelick, M.H. and others. (2004). Difficulty in obtaining peak expiratory flow measurements in children with acute asthma. Pediatric Emergency Care, 20(1), 22-26. doi:10.1097/01.pec.0000106239.72265.16 (classic reference)*
U.S. National Library of Medicine, MedlinePlus. (2018). Peak flow meter use—series. Retrieved January 28, 2019, from http://www.nlm.nih.gov/medlineplus/ency/presentations/100202_1.htm
*In these skills, a “classic” reference is a widely cited, standard work of established excellence that significantly affects current practice and may also represent the foundational research for practice.
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