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Are we recording peak flows properly in young children?
A Greenough1, L Everett, J F Price
1Paediatric Respiratory Laboratory, King's College Hospital, London, UK.
Insights
Three peak flow maneuvers are often insufficient for young children to achieve their maximum peak expiratory flow rate (PEFR). A median of 7% higher PEFR was observed in the second set of three blows, indicating more attempts are needed for accurate asthma monitoring.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Asthma Management
Background:
- Peak expiratory flow rate (PEFR) is crucial for monitoring asthma in children.
- Current practice often relies on the best of three PEFR maneuvers.
- The adequacy of three maneuvers for capturing maximum PEFR in young children is uncertain.
Purpose of the Study:
- To evaluate if three peak flow maneuvers are sufficient to obtain the maximum peak flow rate in young children.
- To determine the reproducibility of PEFR measurements in this age group.
Main Methods:
- Thirty-nine children aged 3-10 years participated.
- Peak expiratory flow rate (PEFR) was measured six times per child at 2-minute intervals.
- Comparison of maximum PEFR from the first three vs. the second three maneuvers.
Main Results:
- Less than half of children (13/39) achieved their maximum PEFR within the first three maneuvers.
- The maximum PEFR from the second set of three blows was a median of 7% greater than the first set.
- A PEFR change greater than 17.6% is needed to demonstrate bronchodilator response, based on an 8.8% coefficient of variation.
Conclusions:
- Three peak flow maneuvers are insufficient for the majority of young children to achieve their maximum PEFR.
- Additional maneuvers are recommended for accurate home monitoring and assessment of bronchodilator response in pediatric asthma.
- Standardizing PEFR measurement protocols is essential for reliable asthma management in children.
Abstract:
Peak flow rate is used in young children to assess bronchodilator response and monitor asthma status at home. Frequently the best of only three peak flow manoeuvres is reported. The aim of this study was to assess if this was sufficient to give the maximum peak flow rate and to determine the reproducibility of the measurement. Thirty nine children aged between three and ten years were recruited. Peak expiratory flow rate (PEFR) was measured six times in each child at two minute intervals. Less than half (13 of 39) of the children made their maximum blow in the first three manoeuvres. The maximum peak flow from the second set of three blows was a median of 7% greater than that from the first three blows. The coefficient of variation of the measurement was 8.8% suggesting a change in PEFR greater than 17.6% is necessary to demonstrate a response to bronchodilator. We conclude three peak flow manoeuvres are insufficient in the majority of young children to demonstrate the maximum peak flow.