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Peak Expiratory
Flow Rate

(PEFR)
PEFR ! What is it ?
 Maximum expiratory flow rate during a forced expiration.

 Indicator of airflow obstruction, primarily measures large airway

function.

 Peak flow is an effort dependent test.

 PEFR are different for everyone. They are based on age, sex and height.

 Useful in diagnosis and monitoring of asthma and diurnal variation.

 Not as useful in COPD.

What is Peak Flow Meter?
 A peak flow meter is a device, which records the peak or maximal flow
during a forced expiratory maneuver (PEFR = Peak Expiratory Flow
Rate).

 In other words, a peak flow meter measures how fast air can be expelled
from the lungs.

 The peak expiratory flow (PEF), also called peak expiratory flow rate
(PEFR) is a person’s maximum speed of expiration, as measured with a
peak flow meter, a small, hand held device used to monitor a person’s
ability to breathe out air.
Peak Flow Meter

 Determine the severity of your asthma.

 Evaluate the effectiveness of your current treatment.

 Determine when to add or stop certain medications.

 Recognize an asthma attack before signs or symptoms appear.

 Decide when to seek emergency care.

Peak Flow Meter

 A portable device that can help measure air flow in and out of the lungs.

 May not be useful for children under the age of 5.

 Can be a good indicator of air flow in and out of the lungs in those over
age 5.
Peak Flow Meters

Modern PEF meters are

relatively inexpensive, potable,
plastic and ideal for patients to
use in home settings for day to
day objective measurement of
airflow limitation.
What are the differences between meters?

 There are 3 things to consider:

1. Brand:
Mini-Wright peak flow meters (EN 13826)

2. Scale
Wright/ATS/EU

3. Range
Low Range Small Child
Standard Range Older Child, Teen, Adult.
Mechanical Peak Flow Meter
Electronic Peak Flow Meter
The Original Wright Peak Flow Meter - Standard and

Low Range Version

 The Mini Wright Peak Flow Meter - Standard and

Low Range versions (From left to right: Wright Scale,

EU Scale, ATS Scale)

Cleaning

 Remove the mouthpiece.

 Rinse it with warm water.

 Run warm water through the entire meter.

 Let the meter air-dry on a clean paper towel.

 Never boil, heat or clean the meter in the dishwasher.

Indication
 Management:

- Determine the severity of asthma.

- Response to treatment during an acute asthma episode.
- Monitor progress in treatment of chronic asthma.
- Detect worsening in lung function.
- COPD.

 Diagnosis:

- Asthma
1. ⇧>=20% in PEFR following administration of a bronchodilators.
2. Diurnal variation >=20%.
- Document the work-relatedness of asthma.
Indication

- Exercise – induced asthma

- Nocturnal asthma (⇩>=15% from the previous…)

 Epidemiological Investigation

- You will see a drop in peak flow readings even before the symptoms of
asthma (like coughing or wheezing) get worse.
- Decreases in peak flow may indicate that you need to increase your
medication.
- The peak flow value can give the physician a better idea of how the
patient are responding to treatment at home.
Indication

- It is difficult to say exactly what a person's best peak flow should be.
For example you can expect:

1. Male; 25 years; 1.85m  627 L/min

2. Female; 40 years; 1.57m  427 L/min
3. Child; 6 - 15years; 1.40m 254 L/min
 Peak Expiratory Flow Rate (PEFR)

Normal Values:

 Normal values vary based on a person’s age, sex and height.

 Peak flow measurements are most useful when a person compares his or
her “personal best”.

 Normal values are related to the patient’s height as follows:

 An easy to remember approximation is:

PEFR (L/min) = [Height (cm) - 80] X 5
Normal values for peak expiratory flow (PEF)
EN 13826 or EU scale

MALE

PEF (L/ min)

FEMALE
Height

Age
 Peak Expiratory Flow Rate (PEFR)

 The average range for an adult for peak flow lie between
PFR 450 (EU) and PFR 600 (EU).

 Because the peak flow depends on age, gender, race and height, the
measured result is compared to that predicted for a person’s age, gender
and height, using special charts and the measurement is compared with
what would be expected.

 Measurements must be compared against a recognized chart of normal

values, but perhaps more importantly as a comparison against the
individual’s normal range.
 Peak Flow Measurement

 Minimum of 3 acceptable blows.

 Standing position is preferred.

 Nose clip not necessary.

 No cough.

 Blow duration 1 to 2 seconds.

 Determining your personal best
 Your “personal best” peak flow rate is the highest peak flow rate you can
reach over a two to three week period when you feel good and have no
asthma symptoms.

 This flow rate serves as a benchmark in your daily self management plan.

 Because everyone’s asthma is different, your personal best will be unique to

you.

 To determine your personal best, typically, you’ll take readings twice a day
for two weeks when you’re not having symptoms.
 Determining your personal best
 The highest consistent reading during the trial period is “personal best”
peak flow rate.

 To take a peak flow reading: Put the marker to zero, take a deep breath, seal
your lips around the mouthpiece, then blow as hard and as fast as you can
into the device, note the reading.

 Repeat three times. The ‘best of the three’ is the reading to record on the chart.

 When recording a peak flow result, the three readings should be within 20
liters per minute of each other; if not the peak flow rate recording should be
repeated up to five times.
 Peak Expiratory Flow Rate (PEFR)

 Lowest in the morning.

 Highest at night.

 Careful instruction is required.

 Effort Dependent.
 Peak Expiratory Flow Rate (PEFR)
 To find your personal best peak flow number, take peak flow readings:

1. Twice a day for two to three weeks when asthma is in good control.
2. At the same time in the morning and in the early evening.
3. You should always use the same peak flow meter and disregard any
readings that are very different from the rest.

 Your personal best PEF is important because it is the number to which all of
your other peak flow reading will be compared.

 Daily measurements are compared to personal best PEF.

 Peak Expiratory Flow Rate (PEFR)

 Your asthma action plan, developed along with your asthma doctor, is
based on this number.

 Once you have determined your personal best PEF, work with your asthma
Care provider to determine at what point you should relieve an asthma
attack or seek emergency medical attention. These are called your asthma
peak flow zones.

 All of this information should be recorded in your personal asthma

action plan.
PEFR Zone
 The color coded zones on a peak flow meter are similar to the signals on a
traffic light representing safety, caution and danger, which is an
indication of whether an individual’s asthma is under control.

Red Zone (Severe Deterioration)

Take supplementary medications.
Go to emergency if no response.

Yellow Zone (Deterioration)

Take supplementary medications.

Green Zone (Control of Asthma)

Take regularly prescribed treatment.
PEFR Zone

Red Zone: Below 50% of Personal Best

Yellow Zone: 50% to 80% of Personal Best

Green Zone: 80% to 100% of Personal Best

Green: 80% - 100% of your Personal Best
 Your breathing is good.
 You do not have any early warning signs or asthma symptoms.
- Take all your medicines every day, as your doctor tells you.
- Take your inhaler before exercise, as your doctor tells you.

Yellow: 60% - 80% of your Personal Best

 Runny, stuffy nose.
 Feel more tired.
 Chin or throat itches.
 Sneezing.
 Restless.
 Red or pale face.
Coughing.
Yellow: 60% - 80% of your Personal Best
 Dark circles under your eyes.
- Use “rescue” medicine.
- Recheck peak flows after 20 – 30 minutes.
- Call your doctor, health care professional, or nurse care manager:
1. If your peak flow is not back up to the Green Zone
2. If your peak flow drops into the Yellow Zone again in less than 4 hours.

Red: Danger Below 60% of your Personal Best

 Cough, more at night.
 Wheezing.
 Chest feels tight or hurts.
 Breathing faster than normal
Red: Danger Below 60% of your Personal Best

 Get out of breath easily

- Use your quick relief medicine by inhaler or nebulizer right away!
- Call your doctor or 911 NOW !!!
Green Zone

 PEFR (Peak Expiratory Flow Rate) 80% to 100% of personal best.

 You should be relatively symptom free and can maintain your current
medical regimen.

 If you are on chronic medications and peak flow is constantly in the green
zone with minimal variation, your physician my consider gradually
decreasing your daily medication.
Yellow Zone

 PEFR 50% to 80% of personal best. “CAUTION” – asthma is worsening.

Acute exacerbation may be present

 A temporary increase in asthma medication is indicated. If you are on

chronic medications, maintenance therapy will probably need to be
increased. Contact your physician to fine tune your therapy.
Red Zone

 PEFR below 50% of personal best. “DANGER” – asthma control is failing.

 Use your inhaled bronchodilator. If peak flows do not return to yellow

zone, as you must employ aggressive therapy under medical direction.
PEFR Zone
 Green: 80% - 100% of personal best.
- Routine treatment can be continued; consider reducing
medications.

 Yellow: 50% - 80% of personal best.

- Acute exacerbation may be present.
- Temporary increase in medication may be needed.
- Maintenance therapy may need to be increased.

 Red: Less than 50% of personal best.

- Bronchodilators should be taken immediately; begin oral steroids;
clinician should be notified if PEF fails to return to yellow or green
within 2 – 4 hours.
Daily Variability of PEFR

PEFR at night – PEFR at morning

X 100%
½ (PEFR at night + PEFR at morning)
Daily Variability of PEFR
 Measurements are lowest in the morning and highest in the evening.

 The magnitude of peak flow variability is generally proportional to the

severity of the disease.

 A diurnal variation in PEF of more than 20% is considered to be diagnostic

of asthma, the magnitude of the variability being broadly proportional to
disease severity.

 In mild intermittent asthma or in severe intractable disease, variability in

PEF may not be present or may be lost.
Daily Variability of PEFR

 In more severe asthma, diurnal variation and reversibility may not be a

feature until after a trial of glucocorticosteroids.

Even then, the more severe forms of the disorder may take many weeks of
treatment before reversibility becomes apparent.
 Monitoring of Asthma Treatment

PEF Daily Variability

Zone
(% Of Best) Of PEF

Green > 80% <20%

Yellow 50% - 80% 20% - 30%

Red <50% >30%

Why we do Peak Flows?
 Peak expiratory flow (PEF) measurements can be an important aid in both
diagnosis and monitoring of asthma.

 PEF measurements are ideally compared to the patient’s own previous best
measurements using his or her peak flow meter.

 For diagnostic purposes

- Comparison to normal / predicted values.

- Reversibility testing – bronchodilator and corticosteroids.
- Peak flow diaries – diurnal variation and serial peak flows.
- Exercise challenge tests.
Why we do Peak Flows?

 To monitor control of asthma

- When necessary monitor

Not a Stand Alone Tool

 Peak flow monitoring should not be used as a substitute or stand alone tool
for monitoring asthma severity.

It should be used in conjunction with symptom assessment, which is the

first and simplest means of monitoring.

Peak flow monitoring is an objective tool to confirm subjective ‘perceptions’

of an individual’s asthma.
Limits of Usefulness

 Because PEFR is dependent on the level of client effort and because it may
be more sensitive to large airway than small airway narrowing, its
usefulness may be limited in some populations, e.g. young children or
individuals who are not highly motivated to give their best effort. Always
do a ‘best of three’ readings.

Spirometry measuring FEV1 is more sensitive to minor narrowing of the

airways.
PEFR – Pros and Cons
 Advantages

- Within 1 to 2 minutes.
- Inexpensive (meter costs less than Php 1000).
- Simple, useful for frequent follow up use.

 Disadvantages

- Very much effort dependent.

- Insensitive to small changes.
- Small airways cannot be assessed.
- Large inter & intra subjects variations; decrease in accuracy.
Peak Flow Meter is Optional !

 Maximum expiratory flow rate.

 Helps in monitoring (Not diagnosis).

 Very effort dependent.

 Poor at detecting early / mild obstruction.

 Cannot distinguish between obstruction and restriction.

Peak Flow Chart
Sample Chart
Peak Flow Chart
Quiz Time !
Bye - Bye !!!
Submitted To:
Erica Fay Acosta

Submitted By:
Harbir Singh (Kento Hirabayashi)
Joana Mae Garcia
Regine Dumlao
CJ Cariaga