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BACKGROUND: Current guidelines for the correct peak expiratory flow (PEF) maneuver include standing. In the hospital setting, PEF values are often ordered to assess response to asthma therapy for acute exacerbations. We have observed that the PEF is sometimes performed with the patient in bed.
METHODS: Healthy adults performed the PEF maneuver in random order (a) standing, (b) lying down at a ~45 degree angle on pillows, and (c) sitting up, slumped forward ~10 degrees with legs extended. PEF was recorded for 3 attempts in each of the 3 positions.
RESULTS: We enrolled 94 subjects (39M, 55F; mean age 24) in 2011. Mean PEF (L/min) in the standing position (669 + 42) was significantly higher than the lying (621 + 42) (p<0.0001) and sitting (615 + 42) positions in males (p<0.0001), and similarly in females, standing produced a significantly higher mean PEF (462 + 42) than lying (422 + 42) (p<0.0001) and sitting (447 + 42) (p<0.05).
CONCLUSIONS: Clinicians should ensure that PEF is obtained with patients out of bed and in the standing position.
Authors: Wallace JL, George CM, Tolley EA, Winton JC, Fasanella D, Finch CK, Self TH
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