An Evaluation of Peak Expiratory Flow Monitoring: A Comparison of Sitting Versus Standing Measurements

The Journal of the American Board of Family Medicine

Jeremy L. Thomas¹  Timothy H. Self³  Emily K. McCoy⁴  Rebecca S. Sowell³  Christopher K. Finch³  Elizabeth A. Tolley²  Christa George⁵ 

[1] Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock (JLT);Departments of Preventative Medicine and Medicine (Pulmonary and Critical Care Medicine), College of Medicine (EAT);Methodist University Hospital (RSS, CKF, THS);Department of Pharmacy Practice, Auburn University Harrison School of Pharmacy (EKM);University of Tennessee-St. Francis Family Practice (CG)

关键词: Peak Expiratory Flow;    Sitting;    Standing;    Reliability;   

DOI  :  10.3122/jabfm.2010.02.090120

学科分类：过敏症与临床免疫学

来源: The American Board of Family Medicine

【 摘 要 】

Introduction: Current guidelines for the diagnosis and management of asthma suggest that patients perform peak expiratory flow (PEF) measurements while standing; however, recent literature suggests this may not be necessary. The purpose of this study was to determine the impact of patient position on PEF measurements.

Methods: A randomized observational analysis of PEF measurements for 211 patients in sitting and standing positions was performed. The highest PEF measurement from tests performed with correct technique in both the sitting and standing position was compared.

Results: Overall, PEF measurements did not significantly differ between the sitting and standing positions (506 ± 2 L/min versus 508 ± 2 L/min; P = .45). No differences were seen between mean PEF measurements in the sitting or standing positions for either women or men, nor were there significant differences between mean PEF values for the sitting and standing positions in participants who reported a history of asthma.

Conclusions: PEF measurements do not significantly differ based on sitting or standing measurements among healthy participants. Based on the results of this study it may not be necessary for the patient to stand while performing PEF measurements. Further study among patients with asthma is warranted.

• Peak Expiratory Flow
• Sitting
• Standing
• Reliability

Asthma is a chronic inflammatory disease of the airways that affects more than 22 million Americans, including almost 7 million children.^1,2 Uncontrolled asthma can cause significant burden to patients, including decreased quality of life, lost days of school or work, hospitalizations, and death. When patients are diagnosed with asthma, it is important to educate them about proper asthma management, including, but not limited to, medication use and adverse effects, inhalation technique, and signs and symptoms of asthma exacerbations.

Appropriate asthma management relies heavily on the patient's ability to regularly self-monitor asthma symptoms. Even well-controlled patients need to be monitored over time to reassess asthma severity and adjust medications as needed. Self-monitoring involves not only the assessment of the frequency and severity of symptoms but also the measurement of pulmonary function, which is often done by measuring the peak expiratory flow (PEF). Daily PEF monitoring can be helpful to detect changes in disease states that require treatment, evaluate response to changes in therapy, and can provide a quantitative measurement of impairment.³ The current National Asthma Education and Prevention Program Expert Panel Report 3 guidelines suggest that, in addition to symptomatic monitoring in asthmatic patients, pulmonary function should also be assessed periodically.³ The Expert Panel suggested that long-term, daily PEF monitoring should be considered for patients who have moderate or severe persistent asthma, who have a history of severe exacerbations, who poorly perceive airflow obstruction and worsening asthma, and for those patients who prefer that method of monitoring.³ Monitoring PEF can assist in determining the severity of the patient's asthma and can guide therapeutic decisions in the home, the school, the clinician's office, or the emergency department.

PEF measurements are also useful in the development of a written Asthma Action Plan, which should be given to every patient with asthma. The Asthma Action Plan should include instructions for both daily management and management of exacerbations (Figure 1). It is important to note that the 3 zones in the Asthma Action Plan are determined by the patient's personal best PEF measurement.

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Figure 1.

Sample Asthma Action Plan. (Reprinted with permission from Regional Asthma Management and Prevention [RAMP], a program of the Public Health Institute. The RAMP Asthma Action Plan was supported by Cooperative Agreement Number 1U58DP001016-01 from the Centers for Disease Control and Prevention. The contents of the RAMP Asthma Action Plan are solely the responsibility of the authors and do not necessarily represent the official views of the CDC.⁴)

Current guidelines suggest that patients be standing as they use their peak flow meter; however, patients may be unable to stand for numerous reasons. Therefore, the purpose of this study is to evaluate what, if any, differences exist between PEF measurements taken in the standing and sitting positions.

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