By Kian Fan Chung; Andrew Bush
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Extra info for Clinicians' guide to asthma
Use as part of an overall self-management plan with stepping up of treatments at specific values of PEFR measurements. INVESTIGATIONS AND LABORATORY ASSESSMENT how soon prior to the measurement of PEFR he has taken bronchodilator therapy, since a post-bronchodilator PEFR measurement may mask the severity of asthma. PEF meter readings may change with extended use, and significant errors may occur in the reading range of many devices, with some over-reading in the middle flow range and under-reading at high flow ranges.
However, PEFR has limitations that need to be recognized. First, it is effort dependent, and proper training is essential to obtain the best and reproducible measurements from an individual patient. Second, the inter-individual variability of PEFR is wide and the predicted values available may not necessarily accurately reflect the 'normal' for a particular patient. It is more useful to establish a best PEFR for each patient during a period of monitoring when the patient is at his best ('best-ever PEFR').
Patients with difficult-to-control asthma despite apparently adequate therapy; 3. g. differentiation of asthma from chronic obstructive pulmonary disease in adults, chronic cough or cystic fibrosis in children; 4. presence of associated aggravating factors, such as sinus disease, rhinitis, nasal polyps and bronchopulmonary aspergillosis; 5. suspicion of occupational factors aggravating or causing asthma; 6. patients needing advice on environmental control, allergen avoidance, smoking cessation or on adherence to therapy.