Peak flow meters

Peak flow meters may be used to assess lung function in

children over 5 years with asthma, but symptom monitoring is the most reliable a
ssessment of asthma control. They are best used for short periods to assess the
severity of asthma and to monitor response to treatment; continuous use of peak
flow meters may detract
from compliance with inhalers.
Peak flow charts should be issued where appropriate,
and are available to purchase from:
3M Security Print and Systems Limited
Gorse Street, Chadderton
Oldham,
OL9 9QH
Tel: 0845 610 1112
GP practices can obtain supplies through their Area
Team stores.
NHS Hospitals can order supplies from www.nhsforms.
co.uk or by emailing nhsforms@mmm.com.
In Scotland, peak flow charts can be obtained by emailing stockorders.dppas@apsg
roup.co.uk.
Standard Range Peak Flow Meter
Conforms to standard EN ISO 23747: 2007
AirZone, range 60 720 litres/minute, net price =
4.63, replacement mouthpiece = 38p (Clement
Clarke)
Medi, range 60 800 litres/minute, net price =
4.50 (Medicare)
MicroPeak, range 60 900 litres/minute, net price =
6.50, replacement mouthpiece = 38p (Micro Medical)
Mini-Wright, range 60 800 litres/minute, net price
= 6.99, replacement mouthpiece = 38p (Clement
Clarke)
Personal Best, range 60 800 litres/minute, net
price = 6.86 (Respironics)
Piko-1 , range 15 999 litres/minute, net price =
9.50, replacement mouthpiece = 38p (nSPIRE
Health)
Pinnacle, range 60 900 litres/minute, net price =
6.50 (Fyne Dynamics)
Pocketpeak, range 60 800 litres/minute, net price
= 6.53, replacement mouthpiece = 38p (nSPIRE
Health)
Vitalograph, range 50 800 litres/minute, net price
= 4.83 (a child s peak flow meter is also available)
(Vitalograph)
Low Range Peak Flow Meter
Compliant to standard EN ISO 23747: 2007 except for
scale range
Medi, range 40 420 litres/minute, net price =
6.50 (Medicare)
Mini-Wright, range 30 400 litres/minute, net price
= 7.04, replacement mouthpiece = 38p (Clement
Clarke)
Pocketpeak, range 50 400 litres/minute, net price
= 6.53, replacement mouthpiece = 38p (nSPIRE
Health)
Drug delivery devices
Inhaler devices A pressurised metered-dose inhaler is
an effective method of drug administration in mild to
moderate chronic asthma; to deliver the drug effectively, a spacer device should

also be used (see also

NICE guidance, below). By the age of 3 years, a child
can usually be taught to use a spacer device without a
mask. As soon as a child is able to use the mouthpiece,
then this is the preferred delivery system.
Dry powder inhalers may be useful in children over 5
years, who are unwilling or unable to use a pressurised
metered-dose inhaler with a spacer device; breath-actuated inhalers may be usefu
l in older children if they are
able to use the device effectively. The child or child s
carer should be instructed carefully on the use of the
inhaler. It is important to check that the inhaler is being
used correctly; poor inhalation technique may be mistaken for a lack of response
to the drug.
On changing from a pressurised metered-dose inhaler to
a dry powder inhaler, the child may notice a lack of
sensation in the mouth and throat previously associated
with each actuation; coughing may occur more frequently following use of a dry-p
owder inhaler.
CFC-free metered-dose inhalers should be cleaned
weekly according to the manufacturer s instructions.
NICE guida nce
Inhale r devices for chi ldren unde r 5 yea rs
with chro nic asthma (Au gust 2000)
A child s needs and likelihood of good compliance
should govern the choice of inhaler and spacer
device; only then should cost be considered.
. corticosteroid and bronchodilator therapy should be
delivered by pressurised metered-dose inhaler and
spacer device, with a facemask if necessary;
. if this is not effective, and depending on the child s
condition, nebulised therapy may be considered and,
in children over 3 years, a dry powder inhaler may also
be considered [but see notes above].
www.nice.org.uk/TA10
142 3.1.4 Compound bronchodilator preparations BNFC 2014 2015
3Respiratory system
NICE guida nce
Inhale r devices for children 5 15 years with
chro nic asthma (March 2002)
A child s needs, ability to develop and maintain
effective technique, and likelihood of good compliance should govern the choice
of inhaler and spacer
device; only then should cost be considered.
. corticosteroid therapy should be routinely delivered
by a pressurised metered-dose inhaler and spacer
device;
. for other inhaled drugs, particularly bronchodilators, a
wider range of devices should be considered;
. children and their carers should be trained in the use
of the chosen device; suitability of the device should
be reviewed at least annually. Inhaler technique and
compliance should be monitored.
www.nice.org.uk/TA38
Spacer devices Spacer devices are particularly useful for infants, for children
with poor inhalation technique, or for nocturnal asthma, because the device
reduces the need for coordination between actuation
of a pressurised metered-dose inhaler and inhalation.
The spacer device reduces the velocity of the aerosol
and subsequent impaction on the oropharynx and

allows more time for evaporation of the propellant so

that a larger proportion of the particles can be inhaled
and deposited in the lungs. Smaller-volume spacers may
be more manageable for pre-school children and
infants. The spacer device used must be compatible
with the prescribed metered-dose inhaler.
Use and care of spacer devices The suitability of
the spacer device should be carefully assessed; opening
the one-way valve is dependent on the child s inspiratory flow. Some devices can b
e tipped to 45 to open the
valve during inhaler actuation and inspiration to assist
the child.
Inhalation from the spacer device should follow the
actuation as soon as possible because the drug aerosol
is very short-lived. The total dose (which may be more
than a single puff) should be administered as single
actuations (with tidal breathing for 10 20 seconds or 5
breaths for each actuation) for children with good
inspiratory flow. Larger doses may be necessary for a
child with acute bronchospasm; for guidance on the
Management of Acute Asthma, see section 3.1.
The device should be cleansed once a month by washing in mild detergent and then
allowed to dry in air
without rinsing; the mouthpiece should be wiped clean
of detergent before use. Some manufacturers recommend more frequent cleaning, bu
t this should be
avoided since any electrostatic charge may affect drug
delivery. Spacer devices should be replaced every 6 12
months.
A2A Spacer (Clement Clarke)
Spacer device, for use with all pressurised (aerosol)
inhalers, net price = 4.15; with small or medium
mask = 6.68
Able Spacer (Clement Clarke)
Spacer device, small-volume device. For use with all
pressurised (aerosol) inhalers, net price standard
device = 4.33; with infant or child mask = 7.06
AeroChamber Plus (GSK)
Spacer device, medium-volume device. For use with
all pressurised (aerosol) inhalers, net price standard
device (blue) = 4.75, with mask (blue) = 7.92;
infant device (orange) with mask = 7.92; child
device (yellow) with mask = 7.92
Babyhale r (A&H) D
Spacer device, paediatric use with Flixotide , and
Ventolin inhalers, net price = 11.34
Haleraid (A&H)
Inhalation aid, device to place over pressurised
(aerosol) inhalers to aid when strength in hands is
impaired (e.g. arthritis). For use with Flixotide , Seretide , Serevent, and Ventol
in inhalers. Available as
Haleraid-120 for 120-dose inhalers and Haleraid200 for 200-dose inhalers, net price = 80p
OptiCha mber (Respironics)
Spacer device, for use with all pressurised (aerosol)
inhalers, net price = 4.28
OptiCha mber Diamond (Respironics)
Spacer device, for use with all pressurised (aerosol)
inhalers, net price = 4.49; with small, medium, or
large mask = 7.49

Pocket Chamber (nSPIRE Health)

Spacer device, small-volume device. For use with all
pressurised (aerosol) inhalers, net price = 4.18;
with infant, small, medium, or large mask = 9.75
Space Chamber Plus (Medical Developments)
Spacer device, for use with all pressurised (aerosol)
inhalers, net price standard device = 4.26; compact
device = 4.26
Volumatic (A&H)
Spacer inhaler, large-volume device. For use with
Clenil Modulite , Flixotide , Seretide , Serevent,
and Ventolin inhalers, net price = 3.81; with paediatric mask = 6.70
Vor tex (Pari)
Spacer device, medium-volume device. For use with
all pressurised (aerosol) inhalers, net price with
mouthpiece = 6.28; with mask for infant or child =
7.99; with adult mask = 9.97D