PEAK FLOW METER

A peak flow meter is a small, hand-held device used to manage asthma

by monitoring airflow through the bronchi and thus the degree of
restriction in the airways. The peak flow meter measures the patient's
maximum ability to expel air from the lungs, or peak expiratory flow
rate (PEFR or PEF). Peak flow readings are higher when patients are
well, and lower when the airways are constricted. From changes in
recorded values, patients and doctors may determine lung functionality,
severity of asthma symptoms, and treatment options.

The measurement of peak expiratory flow was pioneered by Dr. B.M. Wright, who produced the
first meter specifically designed to measure this index of lung function. Since the original design
of instrument was introduced in the late 1950s, and the subsequent development of a more
portable, lower cost version (the 'Mini-Wright' peak flow meter), other designs and copies have
become available across the world

Mini-Wright Peak Flow Meter

Probably the best known peak flow meter, the familiar red and grey colour of Clement
Clarke's meter is recognised by many people around the world. Mini-Wright peak flow
meters are available in both Standard and Low Range - making them suitable for Adults
and Children alike.

The original Mini-Wright peak flow meter was developed in the 1970s by Dr. B.M. Wright, of the
Medical Research Council, and Clement Clarke International, Harlow, England. The Mini-Wright
remains the first choice of healthcare professionals across the world wishing to measure PEF,
even into this new millennium.

PEAK EXPIRATORY FLOW RATE

The peak expiratory flow rate measures how fast a person can exhale air. It is one of many
tests that measure the function of the airways, which are commonly affected by diseases such
as asthma, or chronic obstructive pulmonary disease (COPD, usually a combination of
emphysema and chronic bronchitis).

In these lung diseases, air flow during exhalation is decreased by narrowing or blockage of the
airways. The severity of asthma of COPD can change with time, and peak expiratory flow
monitoring is used by many patients to monitor their lung function at home. This allows them to
anticipate when their breathing will become worse and to take appropriate medications or call
their health care providers before symptoms become too severe.
 MEASUREMENT OF
MAXIMUM
EXPIRATORY FLOW ----
FROM GUYTON

In respiratory diseases, the

resistance to air flow
becomes great during
expiration causing
tremendous difficulty in
breathing.
MAXIMUM EXPIRATORY
FLOW IS DEFINED AS
FOLLOWS:

When a person expires with

great force, the expiratory air
flow reaches a maximum flow beyond which the flow cannot be increased even with
greatly increased additional force.

The maximum expiratory flow is much greater when the lungs are filled with a large
volume of air than when they are almost empty.

Same amount of pressure is applied to the outsides of both the alveoli and the bronchioles
when pressure is applied to the outsides of the alveoli and the passageways. This pressure
force air from the alveoli into the bronchioles and it also tends to collapse the bronchioles
at the same time which will oppose the movement of the air to the exterior. Once the
bronchioles have become almost completely collapsed, further expiratory force can still
greatly increase the alveolar pressure, but it also increases the airway resistance by an
equal amount, thus preventing any increase in flow.

As the lung volume becomes smaller, this maximum expiratory flow also becomes less
because, in an enlarged lung, the bronchi and bronchioles are held open partially via
elastic pull on their outsides by lung structural elements. As the lung becomes smaller,
these structures are relaxed so that the bronchi and bronchioles are collapsed more easily
by external pressure.

IN SHORT: collapse of the respiratory passageway during maximum expiratory effort

limits the expiratory flow rate

As the lung volume decreases, maximum expiratory air flow also decreases.

The total amount of air that can be exhaled is called the forced vital capacity (FVC).
The greatest flow rate achieved during the maneuver is called the peak expiratory
flow rate (PEFR)
Peak Expiratory Flow Rate (PEFR)
This is a simple method of measuring airway obstruction and it will detect moderate or
severe disease. The simplicity of the method is its main advantage. It is measured using
a standard Wright Peak Flow Meter or mini Wright Meter. The needle must always be
reset to zero before PEF is measured.

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

Height (cm) PEFR (L/min)*

120 215
130 260
140 300
150 350
160 400
170 450
180 500

* mean; 2 SD = ±100

An easy to remember approximation is: PEFR (L/min) = [Height (cm) - 80] x 5