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PEAK FLOW

● What is Peak Flow?
● What equipment do we use?
● How do we get valid results?
● What does it tell us?
● Are there limitations?
● When is it useful?
PEAK FLOW
Definition:-

It is the maximum flow achievable from a
forced expiration starting at a full inspiration
with an open glottis

ref:: Guidelines for the measurement of respiratory function.
Respiratory Medicine (1994) 88, 165 - 194
PEAK FLOW
● Hadorn 1942
● Aneroid

● Wright & McKerrow 1959
● Wright meter

● Mini Wright 1978
● Many others 1976 -
PEAK FLOW
Available on prescription BNF March 1999

● Ferraris Pocketmeter £6.42

● Mini Wright £6.74

● Vitalograph £6.65
PEAK FLOW
Causes of reduced peak flow

● Larynx
• tumour, oedema.

● Trachea
• tumour, goitre, strictures, relapsing polychondritis.

● Bronchi
• tumour, foreign body, asthma, COPD, bronchiectasis.

● Lung parenchyma
• tumour

● Chest wall
• ankylosing spondylitis, neuromuscular disease.
PEAK FLOW
‘Normal’

● Normal lung function

● Asthma

● ILD

● Mild COAD

● Asymptomatic smoker
PEAK FLOW
Pitfalls in measurement

● Poor effort
• confusion, weakness, lack of motivation, lack of co-ordination

● Errors in use of mouthpiece
• Leaks, facial palsy, obstruction by tongue /dentures

● Obstruction of cursor or air vents
• by fingers

● Inadequate rest between attempts
● Deliberate falsification
PEAK FLOW
Diagnosis (Asthma) ● Monitoring (Asthma)
● Diurnal variation ● Care plans

● Bronchodilator reversibility – Decide when to add or stop

● Exercise test medication

● Steroid trial – Decide when to seek

emergency help
● Occupational testing
Bronchodilator reversibility
test
Patients Peak flow Predicted Peak flow

Standard dose of bronchodilator given(200 µg salbutamol or 500 µg Bricanyl)
Wait 10 - 15 minutes

Post bronchodilator
Peak flow

Change = best post PEF - best pre PEF
% change =(change/best pre) x 100
Exercise test
Patients demographic details

Time PEF l/min Predicted PEF
0

6 minutes exercise
+5

+10

+15 Post bronchodilator PEF

+20
Steroid trial
30 mg oral prednisolone daily
400
PEF l/min
300

200

100

1 7 14 21 28

Days
PEAK FLOW
● Cleaning
– Manufacturers instructions
● Wash in detergent
● Milton
● Dishwasher
● Glutaldehyde

– Do not take apart
PEAK FLOW

● Calibration
● Very difficult to calibrate flow accurately

● Quality control
● Reference values for ‘normal’ staff