Transcript PEFR <60% of your personal best Danger

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Definition
Indications
Steps
Interpretation
Serial PEFR
Types
Maitenance
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AAAAI
THORAX Journal
American lung
association
European Respiratory
Journal
Caremark Journal
European J of allergy &
clinical immunology
Rom & ladou textbooks
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
Adults and children (over 5 years of age) who
require medication for asthma on a daily or
near-daily basis
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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
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Management:
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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…)
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Epidemiologic 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.
STEPS :
Make sure the
device reads zero
or is at base level
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
Place the meter in your
mouth and close lips
around it.
Do not put your tongue
inside the hole
Blow out as hard
and as fast as
possible (one to
two seconds)
Do not cough or let
the tongue block
the mouthpiece
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.
Check which zone
corresponds with
your highest score.
Follow the plan
developed by you
and your doctor for
the appropriate
zone
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
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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.
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.
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
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
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%
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.
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.
PEFR <60% of your personal
best
Danger
Use your quick-relief medicine
by inhaler or nebulizer right
away!
Call your doctor or115
guide to aid patients in asthma
management.
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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.
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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
Is often the best way to document the workrelatedness 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).
>=20% diurnal variability
in PEFR is considered
evidence of an asthmatic
response.
The major advantage :
detect late responses
that occur after the work
ends.
Serial PEFR for 2-3 weeks at work & at least 10
days off work.
Recording: every 2 h
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.
There are 3 things to consider:
Brand :
Mini-Wright peak flow meters
EN 13826
Scale
Wright/ATS/EU
Range
low range small child.
standard range older child, teen, adult.
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The Original Wright Peak Flow Meter Standard and Low Range versions
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The Mini Wright Peak Flow Meter - Standard
and Low Range versions (from left to right:
Wright scale, EU scale, ATS scale)
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Other designs of peak flow meters are
available
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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
Thanks for your attention
Atena farjamy
86.7.17