Peak flow and Inhalers

Question 1

How to use the Peak Flow meter

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 Peak Flow Meter level
6. Hold meter horizontally so that fingers do not touch the slide
7. Forcefully exhale as rapidly as possible into meter
8. Read directly from scale
9. Record the best of three attempts and mark in an appropriate position on the chart
10. Dispose of the used mouthpiece appropriately
11. Calculate what the expected peak PEFR is from their height, age and gender using the predicted values chart

Question 2

What should you tell the patient about PEFR results?

Answer 2

Tell the patient what their expected PEFR is and if they are below this, explain that 100 litres per minute in males and 85 litres per minute in females below this figure is normal

Question 3

What are the four core groups of inhaler devices?

Answer 3

1. Conventional pressurised metered dose inhalers (pMDIs)
2. Pressurised metered dose inhalers with a spacer device
3. Breath-actuated pressurised metered dose inhalers
4. Dry powder inhalers

Question 4

Technique for using a Pressurised metered-dose inhaler

Answer 4

1. Sit up straight or stand up and lift the chin to open the airways
2. Remove the cap from the mouthpiece
3. Shake the inhaler
4. Breathe out gently
5. Immediately place the mouthpiece in your mouth and put your teeth around it, do not bite it
6. Start to breathe in slowly and deeply through the mouthpiece. As you breathe in, simultaneously press the canister to release one puff of medication. Do not keep pressing. continue to breath in to maximum amount possible
7. Hold your breath for 10 seconds, or as long as possible
8. If a second dose of medication is required, wait 30-60 seconds before taking a second puff. Repeat the procedure if necessary
9. Replace the cap

Question 5

How to use a Large-Volume Spacer Device

Answer 5

1. Remove the cap of the pMDI
2. Shake the inhaler and insert into the spacer device
3. Place the mouthpiece into the mouth
4. Ensure the valve can be opened by breathing in and out slowly (a ‘clicking’ sound will be heard)
5. Press the canister, keeping the inhaler in the chamber
6. Take a deep, slow breath in Hold the breath for about 10 seconds or as long comfortable then breathe out through the mouthpiece
7. Remove the device from the mouth
8. For a further dose, wait 30-60 seconds before repeating technique