Peak flow meter

Overview: 

A peak flow meter (PFM) is a device that measures the full capacity of the lungs. It measures the exhalation of air after total inhalation at the maximum capacity of the lungs. It is a simple, easily learnable, affordable device. This can be done at home to check the lungful air exhalation. It is a portable hand-held device that measures the ability to push out the air. Based on the amount of air blown out in one fast blast breathing capability can be monitored. 

About the Device: 

A peak flow meter is also known as a peak expiratory flow measurement device. Peak flow is a simple measure of the maximum expiratory capacity of the lungs when an individual blows air into the device. They are used in asthma to measure the amount of air exhaled. These devices are of two types manual and digital. The manual device has markings to track the amount of air exhaled, whereas digital devices give a direct display of the measurement. By displaying the amount of maximum air that can be exhaled, these devices help in asthma management. 

Indications: 

 PFM devices are mainly used as tools to manage asthma. It determines an individual’s “personal best” peak flow when an individual is under maximum asthma control using the medication. This number helps to evaluate the disease and measure the prognosis. Using the device for monitoring asthma can be done based on individual disease activity. It can also be used to identify the triggers that worsen the asthma. 

For individuals with no pronounced symptoms but with increasing disease activity, this device helps to identify the deterioration of the disease and prompt intervention. Individuals with worsening expiratory flow and symptoms, as indicated by the PFM reading, require hospitalization to monitor for respiratory failure. Standard PFM measurements based on height and weight can also be used to monitor disease when personal best PFM measurements are not known. 

Advantages: 

PFM has many advantages like 

• It is simple and easy to learn and use
• It is easily learnable 
• It helps in knowing the maximum lung capacity 
• It is affordable 
• It helps to monitor disease activity 
• It gives a prior indication of the worsening of the disease 
• It can be reused many times 
• It can be trainable even among children > 5 years of age

Using the device: 

Before using the device make sure all the parts of the device are intact. To measure the peak flow using the device one has to keep themselves in a comfortable position by sitting or standing up. Standing comfortably makes breathing easier. Before using the device make sure the marker is at the bottom or zero of the device. 

After relaxing, take a deep breath and fill the lungs. Forward movement of the abdominal muscles indicates that the lungs are filled. Holding the device in one hand, place the mouth around the mouthpiece of the device and seal the lips tightly around the mouthpiece. This ensures no air is leaking from the mouth into the surrounding atmosphere. Blow the air from the lungs into the device as fast as possible in a single exhale. 

The meter moves as per the amount of air exhaled. Note the reading on the meter. To avoid any discrepancy, repeat the process three times by giving a gap in between. The highest of the three readings gives the daily peak flow. Peak flow reading is measured by the number on the meter shows the liters of air exhaled per minute. It is advisable to record symptoms like wheezing, difficulty in breathing, chest tightness, and cough. Also, one should inform the healthcare professional of the medications or rescue inhalers that are being used. 

Personal best PFM: 

Personal best PFM is the best number that one can get while using the device. To get this one has to do the test twice a day regularly for two weeks. To obtain accurate results repeat the test at the same time of the day in the morning and evening. Do the test before taking any inhalers or medicine. The highest number that is obtained when doing the test for two weeks gives the personal best peak flow. 

Personal peak expiratory flow gives the number against which the daily expiration can be measured. This can help in identifying the disease progression. Personal best PFM varies from individual to individual based on height, weight, and sex. Personal best PFM or daily PFM does not alter with volumetric changes in pregnancy. Any worsening of PFM readings should be considered as disease progression. 

Interpretation of PFM:

Any peak flow meter has three zones indicated by the gauge marker. These zones interpret the flow scores. The three zones are the green zone, red, and yellow zone. 

• Green Zone: Marking in the green zone indicates that the patient’s asthma is in good control and in a stable state. This zone is set at 80-100% of personal best PFM. When the patient is asymptomatic, it is better to continue the same regimen used by the patient without any changes. 
• Yellow Zone: Repeated markings in the yellow zone indicate that the patient’s asthma is not under good control and has to start an action plan. This zone is set at 50-80% of personal best PFM. Standard home action plans are advised to the patient like avoiding noxious stimuli that increase the asthma and altering the dosages of the inhalers. 
• Red Zone: Markings in this zone indicate a serious airway problem and an emergency. PFM at the red zone indicates < 50% of the expiration. Patients are advised to step up the treatment by the healthcare provider based on their condition. 

Risks and contraindications: 

Using PFM can cause dizziness, lightheadedness, and continuous cough. Sometimes inaccurate readings can be obtained when one does not use the PFM correctly or uses medication before using the PFM. 

Conclusion: 

The peak flow meter is a vital adjunctive tool in asthma management. It measures the maximum capacity of lung expiration. It helps in disease monitoring and guides the management. It is safe, simple, affordable, and easy to use. 

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