2.  Definition  Indications  Steps  Interpretation  Serial PEFR  Types  Maitenance

3.  AAAAI  THORAX Journal  American lung association  European Respiratory Journal  Caremark Journal  European J of allergy & clinical immunology  Rom & ladou textbooks

4. Portable, inexpensive, hand-held device used to measure how air flows from lungs in one "fast blast (PEFR). A peak flow meter for asthma is like a thermometer for a fever. Reflects the degree of airway obstruction Liters/min

5. Adults and children (over 5 years of age) who require medication for asthma on a daily or near-daily basis

6.  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

7.  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  Dx: ◦ asthma  ⇧>=20% in PEFR following administration of a bronchodilator.  Diurnal variation >=20% ◦ ِ Document the work-relatedness of asthma ◦ Exercise – induced asthma ◦ Nocturnal asthma(⇩>=15% from the previous…)  Epidemiologic investigation

8. 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.

9. STEPS :

10. Make sure the device reads zero or is at base level

11. Stand up straight. (unless handicapped, in which case the position should be the same for all maneuvers) Nose clips are unnecessary Take a deep breath as far as possible

12. Place the meter in your mouth and close lips around it. Do not put your tongue inside the hole

13. Blow out as hard and as fast as possible (one to two seconds) Do not cough or let the tongue block the mouthpiece

14. Write down the value obtained Move the marker back to the bottom, and repeat these steps two more times. If you cough or make a mistake, do not include this as one of your three tries. Record the highest of the three numbers in your chart.

15. Check which zone corresponds with your highest score. Follow the plan developed by you and your doctor for the appropriate zone zone

16. Measure your PFR close to the same time each day Twice daily between 7-9 a.m & 6-8 p.m Keep a chart of your PFRs

17.  When asthma is well controlled, there should be very little difference between the day-to-day readings or between the morning and evening readings.  The main clue to uncontrolled asthma is readings that change a lot from day-to-day or between morning and evening.

18. predicted "normal" peak flow is determined by height, age, sex and race. it is preferable to gauge asthma control by comparing daily peak flow recordings with "personal best" reading.

19. it is difficult to say exactly what a person's best peak flow should be. For example you can expect: M,25yr, 1.85m  627 L/min F,40yr,1.57m  427 L/min child,6-15yr,1.40m  254 L/min

20. Is the highest peak flow number a patient can achieve over a 2-3 week period when his or her asthma is under good control. Personal best values will change as child. grow taller and as disease status changes⇝periodically readjust personal best. To determine personal best: Always use the same peak flow meter Record peak flow twice a day for two weeks Ignore outlying values

21. 3 zones of measurement are commonly used to interpret PFRs It is easy to relate the 3 zones to the traffic light colors: green, yellow, red. A normal PFR can vary as much as 20%

22. PEFR 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.

23. PEFR 60-80% of your personal best Caution Use "rescue" medicine Recheck peak flow after 20-30 min. Call your doctor if :  your peak flow is not back up to the Green Zone  if you continue to need rescue medicine in less than 4 h.

24. PEFR <60% of your personal best Danger Use your quick-relief medicine by inhaler or nebulizer right away! Call your doctor or115

26. guide to aid patients in asthma management.

29.  Your peak flow meter is only an aide to you. Do not rely on your peak flow numbers alone when deciding whether to take your rescue medicine or call your doctor. Your symptoms also need to be considered.

30.  Early warning signs of an asthma attack:  Runny, stuffy nose  Fatigue  Chin or throat itches  Headache  Moodiness  Cough with activity or laughing  Wheezing with activity  Waking up at night or early morning with a cough or wheeze  Faster breathing rate  Irritability

36. Is often the best way to document the work- relatedness of asthma. at least 4 times daily over 2 weeks 4 weeks with 2 hourly measurements. The time of "Waking Up", "Starting Work", "Ending Work" and "Going To Bed“ on each day plus at time of acute chest tightness Always done before medication Record daily responses as (yes/no): exposure, tight chest, respiratory infection; also, use of inhaled bronchodilator (number of times).

37. >=20% diurnal variability in PEFR is considered evidence of an asthmatic response. The major advantage : detect late responses that occur after the work ends.

39. Serial PEFR for 2-3 weeks at work & at least 10 days off work. Recording: every 2 h

40. A consistent pattern of a change in PEFR which is greater than 25%at work Increased daily variability should be associated with PEFR deterioration. deterioration in PEFR in work week improvement in non-work periods.

43. There are 3 things to consider: Brand : Mini-Wright peak flow metersMini-Wright peak flow EN 13826 Scale Wright/ATS/EU Range low range  small child. standard range  older child, teen, adult.

46. The Original Wright Peak Flow Meter - Standard and Low Range versions

47. The Mini Wright Peak Flow Meter - Standard and Low Range versions (from left to right: Wright scale, EU scale, ATS scale)

48. Other designs of peak flow meters are available

50.  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

51. Thanks for your attention Atena farjamy Atena farjamy 86.7.17 86.7.17