Peak Expiratory Flow Monitoring in Asthma Management

Introduction to Home PEF Monitoring

The American Thoracic Society/European Respiratory Society recommends home monitoring as the optimal use case for PEF in asthma management, providing an objective day-to-day assessment of airway obstruction for within-patient comparisons over time 1

Home lung function measurement helps detect deterioration and guide treatment changes, particularly in patients with refractory asthma who often have reduced perception of their airflow limitation 5
Sequential measures of PEF variability correlate with increased airway responsiveness, and diurnal variability >13% is an important diagnostic characteristic of asthma 5

Adequate training is mandatory for home PEF monitoring, with good within-session reproducibility achievable with proper training, and technique should be checked at every clinic visit 6
The same instrument should be used on each occasion if possible to ensure consistency 1, 3
Patients should record PEF before taking routine study medication and preferably before reliever medication, with most studies using morning recordings either on arising or within a specified time-window 6
Patients should complete symptom diaries before measuring PEF to avoid bias, and the highest value from three maneuvers is usually analyzed 6

In children, home PEF monitoring has significant limitations, with approximately 50% of children aged 4-8 years unable to perform PEF maneuvers adequately 7
For patients with refractory asthma, aggressive home monitoring is specifically indicated, as these patients often demonstrate low perception of their functional status 5

Compact electronic devices now make daily home monitoring of FEV1 a realistic and successful alternative to PEF monitoring 1, 3