Peak Expiratory Flow Rate

Question 1

Explain the 11 steps of PEFR procedure.

Answer 1

1. Wash your hands
2. Zero the device
3. Patient should stand (where possible)
4. Take maximum inspiration
5. Make airtight seal with mouth around mouthpiece, holding PEFM level
6. Hold meter horizontally so that fingers do not touch the slide
7. Forcefully exhale as rapidly as possible into the meter
8. Read directly from scale
9. Record the best of three attempts and mark in an appropriate position (morning, midday or night) on chart
10. Dispose of mouthpiece appropriately
11. Calculate what the expected peak PEFR is from their height, age and gender using the predicted values chart

Question 2

7 steps of explaining this to a patient

Answer 2

1. First we show the patient by doing what was on previous Q, then observe them trying it out for themselves.
2. Explain the recording chart to the patient
3. Ask patient to perform the test, three times daily (each time taking the best result of 3) for 2 weeks then return for a review
4. Inform the patient that readings taken before and 15 mins after use of b agonist inhaler are sometimes useful
5. Tell patients what their expected PEFR is and explain that if male = 100, female = 85 l/m below is still thought to be normal in range
6. Show patient an example of a completed chart so that they can monitor their own progress
7. Calibrate the amount of information you give them against their current level of understanding of PEFR in relation to asthma.