Peak Expiratory Flow Rate Measurement

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Peak expiratory flow rate (PEFR) is the maximum flow rate generated during a forceful exhalation, starting from full lung inflation. ^[1] PEFR 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; thus, low values may be caused by a less than maximal effort rather than by airway obstruction. Nevertheless, the ease of measuring PEFR 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.

Forced expiratory volume over 1 second (FEV₁) is a dynamic measure of flow used in formal spirometry. It represents a truer indication of airway obstruction than does PEFR. Although PEFR usually correlates well with FEV₁, this correlation decreases in patients with asthma as airflow diminishes. ^[2]

PEFR monitoring can be accurately performed by most patients older than 5 years. It is most commonly measured by a portable flow gauge device (peak flow meter [PFM]) but may also be obtained by a transducer that converts flow to electric output during spirometry (pneumotachometer). ^[3]

The most frequent use of PEFR measurement is in home monitoring of asthma, where it can be beneficial in patients for both short- and long-term monitoring. When properly performed and interpreted, PEFR measurement can provide the patient and the clinician with objective data on which to base therapeutic decisions.

Indications for PEFR measurement are as follows:

A study by Murata et al indicated some usefulness of PEFR measurements in patients with COPD for daily monitoring. ^[7]  Another study used peak flow as a predictor of demise from COPD. ^[8]

Providing feedback on predicted PEFR may improve both perception of respiratory compromise and adherence to controller medications in urban ethnic minority children. ^[9]

A prospective study in Turkey found a training program that included PEFR measurement to be effective in increasing self-efficacy and improving asthma symptoms among children and adolescents aged 10 to 18 years. ^[10]

No contraindications exist for PEFR measurement.

In 2007, an expert panel of the National Asthma Education and Prevention Program (NAEPP) recommended periodic assessment of pulmonary function by spirometry or PEFR monitoring. ^[11]  If PEFR monitoring is performed, a written asthma action plan should use the patient’s personal best peak flow, rather than published norms, as a reference value.

The panel recommended consideration of long-term daily PEFR monitoring or home peak flow rate assessment during exacerbations for patients with the following:

In managing chronic asthma, long-term daily PEFR monitoring may assist with the following measures:

The use of PEFR during acute asthma exacerbations is controversial. The 2007 NAEPP report suggested that measuring PEFR in acute asthma episodes helps determine the severity of exacerbations and assists in guiding therapeutic decisions in the home, school, practitioner’s office, and emergency department (ED). ^[11] However, Eid et al reported that PEFR measurement is unreliable for the classification of asthma severity. ^[3]

Compliance with PEFR monitoring is limited by the difficulty that patients and their caregivers often have with keeping records. In one study of inner-city children, monitoring decreased 30% over the course of 3 weeks. ^[12]  Kamps et al noted that children have poor compliance with recording PEFR measurements in symptom diaries. ^[13]

Self et al reported that PFMs are frequently incorrectly used by both children and adults. ^[14] PEFR measurement may be of lower utility in younger children ^[15] and elderly patients, but it has been shown to be of greater benefit in children who are poor or are members of minority groups. ^[16]

Ayala et al noted that provider communication about PEFR measurement was infrequent but that such communication predicted accurate PFM use in children with asthma. ^[17] In a study of adults, adherence was greatly improved by using an electronic device. ^[18]

Compliance with PEFR monitoring is also limited by the lack of ability, on the part of most clinicians, to interpret the data in a meaningful way. Numerous scales and charts are available, but many of them are difficult to interpret. ^{[19, 20]}

There are conflicting data regarding the efficacy of PEFR monitoring for improving asthma outcome. ^[21]  Most studies have shown a benefit when PEFR monitoring is linked to a comprehensive program, combined with symptom diaries and patient education. ^{[22, 23, 24]}

However, one meta-analysis found PEFR monitoring to be equivalent to symptom-based asthma action plans. ^[25]  Another study suggested that with symptom-based monitoring, some patients underestimate the severity of their condition and use medication inappropriately. ^[26]  Gray et al reported that low baseline PEFR predicted unsuccessful treatment of adults with severe asthma. ^[27]

DeVrieze BW, Bhimji SS. Peak Flow Rate Measurement. Treasure Island, FL: StatPearls Publishing; 2018. [Full Text].

Gibson PG. Monitoring the patient with asthma: an evidence-based approach. J Allergy Clin Immunol. 2000 Jul. 106 (1 Pt 1):17-26. [Medline]. [Full Text].

Eid N, Yandell B, Howell L, Eddy M, Sheikh S. Can peak expiratory flow predict airflow obstruction in children with asthma?. Pediatrics. 2000 Feb. 105 (2):354-8. [Medline]. [Full Text].

Enright P, McCormack M. Assessing the airways. Chron Respir Dis. 2008. 5 (2):115-9. [Medline].

Chan CC, Wu TH. Effects of ambient ozone exposure on mail carriers’ peak expiratory flow rates. Environ Health Perspect. 2005 Jun. 113 (6):735-8. [Medline]. [Full Text].

So JY, Lastra AC, Zhao H, Marchetti N, Criner GJ. Daily Peak Expiratory Flow Rate and Disease Instability in Chronic Obstructive Pulmonary Disease. Chronic Obstr Pulm Dis. 2015 Nov 11. 3 (1):398-405. [Medline]. [Full Text].

Murata GH, Kapsner CO, Lium DJ, Busby HK. Patient compliance with peak flow monitoring in chronic obstructive pulmonary disease. Am J Med Sci. 1998 May. 315 (5):296-301. [Medline].

de la Iglesia F, Díaz JL, Pita S, Nicolás R, Ramos V, Pellicer C, et al. Peak expiratory flow rate as predictor of inpatient death in patients with chronic obstructive pulmonary disease. South Med J. 2005 Mar. 98 (3):266-72. [Medline].

Feldman JM, Kutner H, Matte L, Lupkin M, Steinberg D, Sidora-Arcoleo K, et al. Prediction of peak flow values followed by feedback improves perception of lung function and adherence to inhaled corticosteroids in children with asthma. Thorax. 2012 Dec. 67 (12):1040-5. [Medline]. [Full Text].

Cevik Guner U, Celebioglu A. Impact of symptom management training among asthmatic children and adolescents on self-efficacy and disease course. J Asthma. 2015 Oct. 52 (8):858-65. [Medline].

[Guideline] National Asthma Education and Prevention Program. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma: Full Report 2007. National Heart, Lung and Blood Institute. Available at https://www.nhlbi.nih.gov/sites/default/files/media/docs/asthgdln_1.pdf. August 2007; Accessed: March 9, 2018.

Redline S, Wright EC, Kattan M, Kercsmar C, Weiss K. Short-term compliance with peak flow monitoring: results from a study of inner city children with asthma. Pediatr Pulmonol. 1996 Apr. 21 (4):203-10. [Medline]. [Full Text].

Kamps AW, Roorda RJ, Brand PL. Peak flow diaries in childhood asthma are unreliable. Thorax. 2001 Mar. 56(3):180-2. [Medline]. [Full Text].

Self TH, George CM, Wallace JL, Patterson SJ, Finch CK. Incorrect use of peak flow meters: are you observing your patients?. J Asthma. 2014 Aug. 51 (6):566-72. [Medline].

Gorelick MH, Stevens MW, Schultz T, Scribano PV. Difficulty in obtaining peak expiratory flow measurements in children with acute asthma. Pediatr Emerg Care. 2004 Jan. 20 (1):22-6. [Medline]. [Full Text].

Yoos HL, Kitzman H, McMullen A, Henderson C, Sidora K. Symptom monitoring in childhood asthma: a randomized clinical trial comparing peak expiratory flow rate with symptom monitoring. Ann Allergy Asthma Immunol. 2002 Mar. 88 (3):283-91. [Medline]. [Full Text].

Ayala GX, Gillette C, Williams D, Davis S, Yeatts KB, Carpenter DM, et al. A prospective examination of asthma symptom monitoring: provider, caregiver and pediatric patient influences on peak flow meter use. J Asthma. 2014 Feb. 51 (1):84-90. [Medline].

Reddel HK, Marks GB, Jenkins CR. When can personal best peak flow be determined for asthma action plans?. Thorax. 2004 Nov. 59 (11):922-4. [Medline]. [Full Text].

Wisnivesky JP, Lorenzo J, Lyn-Cook R, Newman T, Aponte A, Kiefer E, et al. Barriers to adherence to asthma management guidelines among inner-city primary care providers. Ann Allergy Asthma Immunol. 2008 Sep. 101 (3):264-70. [Medline].

Lum EY, Sharpe HM, Nilsson C, Andrews EM, Tsuyuki RT, Mayers I, et al. Urban and rural differences in the management of asthma amongst primary care physicians in Alberta. Can J Clin Pharmacol. 2007 Fall. 14 (3):e275-82. [Medline].

Bhogal S, Zemek R, Ducharme FM. Written action plans for asthma in children. Cochrane Database Syst Rev. 2006 Jul 19. 3:CD005306. [Medline]. [Full Text].

Ignacio-Garcia JM, Gonzalez-Santos P. Asthma self-management education program by home monitoring of peak expiratory flow. Am J Respir Crit Care Med. 1995 Feb. 151 (2 Pt 1):353-9. [Medline]. [Full Text].

Lahdensuo A, Haahtela T, Herrala J, Kava T, Kiviranta K, Kuusisto P, et al. Randomised comparison of guided self management and traditional treatment of asthma over one year. BMJ. 1996 Mar 23. 312 (7033):748-52. [Medline]. [Full Text].

Brouwer AF, Brand PL. Asthma education and monitoring: what has been shown to work. Paediatr Respir Rev. 2008 Sep. 9 (3):193-9; quiz 199-200. [Medline]. [Full Text].

Powell H, Gibson PG. Options for self-management education for adults with asthma. Cochrane Database Syst Rev. 2003. CD004107. [Medline]. [Full Text].

Bheekie A, Syce JA, Weinberg EG. Peak expiratory flow rate and symptom self-monitoring of asthma initiated from community pharmacies. J Clin Pharm Ther. 2001 Aug. 26 (4):287-96. [Medline]. [Full Text].

Goodacre S, Bradburn M, Cohen J, Gray A, Benger J, Coats T, et al. Prediction of unsuccessful treatment in patients with severe acute asthma. Emerg Med J. 2014 Oct. 31 (e1):e40-5. [Medline].

Liu AH. Biomarkers and childhood asthma: improving control today and tomorrow. Allergy Asthma Proc. 2005 Jul-Aug. 26 (4):249-54. [Medline]. [Full Text].

Harirah HM, Donia SE, Nasrallah FK, Saade GR, Belfort MA. Effect of gestational age and position on peak expiratory flow rate: a longitudinal study. Obstet Gynecol. 2005 Feb. 105 (2):372-6. [Medline].

Radeos MS, Camargo CA Jr. Predicted peak expiratory flow: differences across formulae in the literature. Am J Emerg Med. 2004 Nov. 22 (7):516-21. [Medline]. [Full Text].

Hankinson JL, Odencrantz JR, Fedan KB. Spirometric reference values from a sample of the general U.S. population. Am J Respir Crit Care Med. 1999 Jan. 159 (1):179-87. [Medline]. [Full Text].

Daniel R Neuspiel, MD, MPH, FAAP Professor Emeritus of Pediatrics, Atrium Health (formerly Carolinas HealthCare System)

Daniel R Neuspiel, MD, MPH, FAAP is a member of the following medical societies: Academic Pediatric Association, American Academy of Pediatrics, Phi Beta Kappa

Disclosure: Nothing to disclose.

Cheryl D Courtlandt, MD Faculty, Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine; Medical Director, Pediatric Asthma Program, Attending Physician, Department of Pediatrics, Levine Children’s Hospital, Carolinas Medical Center

Cheryl D Courtlandt, MD is a member of the following medical societies: Academic Pediatric Association, American Academy of Pediatrics, National Medical Association

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Zab Mosenifar, MD, FACP, FCCP Geri and Richard Brawerman Chair in Pulmonary and Critical Care Medicine, Professor and Executive Vice Chairman, Department of Medicine, Medical Director, Women’s Guild Lung Institute, Cedars Sinai Medical Center, University of California, Los Angeles, David Geffen School of Medicine

Zab Mosenifar, MD, FACP, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Thoracic Society

Disclosure: Nothing to disclose.

Michael R Filbin, MD, FACEP Clinical Instructor, Department of Emergency Medicine, Massachusetts General Hospital

Michael R Filbin, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, Massachusetts Medical Society, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Thanks to Yiqing Alex Sheng for posing for photographs.

The authors and editors of Medscape Reference gratefully acknowledge the assistance of Lars Grimm with the literature review and referencing for this article.

Peak Expiratory Flow Rate Measurement

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