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Peak Expiratory Flow Meter Use - How to Measure PEFR in Asthma - Clinical Skills - Dr Gill
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- čas přidán 17. 08. 2024
- How to Use A Peak Flow Meter - PEFR in Asthma diagnosis - Inhaler Demonstration - Dr Gill
Dr James Gill teaches you how to use a peak flow meter, and discusses the 20% diurnal variation which is looked for as part of diagnosing asthma in someone above the age of 17
A peak flow meter is a portable, easy-to-use tool that measures how well your lungs are functioning, by allowing comparison of the speed at which you can exhale - your peak expiratory flow rate (PEFR) - in Litres per minute - hence a cor3 Health Assessment test
Your PEFR is compared against your predicted PEFR based on your height, age and sex which all allow you to determine how well your asthma is controlled.
The video will look not only at how to use a peak flow meter, but also how to use a Respitmat, Salbutamol MDI and Elipta inhalers
#Asthma #Peakflowmeter #DrGill
You can now consult via video or in person with Dr Gill at Dr Finlay’s Private Practice - www.drfinlays....
00:00 - Peak Flow Meter for Asthma Monitoring
00:27 - Personal Asthma Story
01:28 - Peak Flow Meter: Importance and Usage
02:00 - Peak Flow Reading Technique
04:02 - Repeating Peak Flow Reading for Accuracy
05:10 - Peak Flow Calculations
06:08 - Exertional Asthma
06:51 - Demonstrating Inhaler Usage
08:25 - Different Inhaler Types: Respimat Inhaler
10:04 - Ellipta: A Breath-Actuated Inhaler
12:15 - Rechecking Peak Flow After Inhaler Use
13:25 - Diagnosing Asthma with Peak Flow Meter Variability
15:30 - Final Thoughts
Dr. Gill, Can you explain why one’s “force” of air in a breath is more important than the “volume” of air in a breath? My asthma makes me feel like I can’t get enough air in my lungs. So what does the force of one’s breath tell my physician?
Asthma is a REVERSIBLE airway disease. So the easiest way to think about it is not as force, but speed, hence L/min
If you use a straw, it will take a lot longer to water the plants than using the hose pipe.
It doesn’t matter than the water is coming from a reservoir up the road (lung volume) it matters how quickly you can get the water out of pipe/straw (peak flow, ie speed)
I think I’ll do a video on spirometry, it’s quite interesting and looks at yet another measurement FEV1, which is even more accurate, forces expiratory volume over 1 second
Hope that helps?
Ahhh yes, that visualization is extremely helpful. I think I’m getting the concepts of lung capacity to peak flow confused… you as the physician are still concerned about how much water that reservoir can hold, but peak flow doesn’t give you that information. Spirometry will??
I would very much look forward to a video/explanation on spirometry.
Thank you for all these videos. You should constantly be reminded how helpful they are to non-medical people as well as your medical students!!
Lung volume is more important in obstructive lung diseases like COPD
Okay now it’s all clicking…. Asthma is a flow problem where as COPD is a capacity problem.
Thank you again! Taking the time you do to educate everyone around the world must be exhausting! 😅
Kind of, but you will also get a blending, so can have asthma with COPD just to complicate things!
Dr Gill... that thumbnail though 🙈🤣
seriously though, this video is great information.. thank you.
It very likely will get changed, but I wanted to get this video out of the door today
@@DrJamesGill don’t you dare change a thing ☺️
@@diesenpai_ I second this!! 😂
your way of speaking is very calm and reassuring. it’s very inspirational guidance for a lowly med student such as myself. keep up the excellent work dr gill
No such thing as lowly medical student. Or “just a GP”
Everyone has had to work to get where they are. Be proud of yourself as there will be plenty who will want to suppress you 😊
@@DrJamesGill Upon reflection of my previous comment, I do apologise and realise that indeed it did take a gargantuan amount of work to reach the position I am in, of which I am extremely grateful, albeit had forgotten about. I shan't demean the effort I had put in by calling 'so and so' as lowly anymore. Thank you. I ought to carry myself with confidence to put others (team and patient/s) at ease. This is part of my personal learning curve. :)
Jesus, I'm so happy, my asthma receded into almost nothing over last ten years (only the allergic part is happening, but it has softened a lot and is totally controllable by anti histamins, and even that I have managed to reduce), at least, comparing to what I had experienced before.. Inhalers, pf-meters, daily attacks, movement and allergic reactions... And, 20-25 years ago, there was nearly nothing there to help you, comparing to today. I'm 36 now, and I have no idea what has helped me, gym probably, or whatever. You people take care there and keep going...
👍
You sound so kind and caring in your teaching ... It didn't feel like a video... I felt I'm in a class and you r teaching us thats how much you used your skills to make us connected to you
not interested in medicine i came here just for the asmr ty
Dr Gill, I’m a biomedical professional and love to see your videos, such a big source of knowledge! Greetings from Brazil!
Thanks. It can be quite fun making some of them 😊 I’m always crossing my fingers people find them useful
@@DrJamesGill impossible not to like your videos, you’re a genius! 😊👏🏻
Well for some reason all the metrics are going down at the moment, so someone doesn’t like them!
But I’m of the view that as long as they are helping the students, and that people think they are useful enough to share, I’m happy to keep putting them up 😊
@@DrJamesGill brilliant! Thank you! 🤩
👍
This is actually really helpful! I've just started working as a pharmacy tech, and this answers a lot of my questions about the different inhalers.
Glad it was useful. Any others you wonder about, I’ll see if o can get demo inhalers for them
This was very interesting because I remember my grandfather having to use one of those when he was recovering from his lung cancer surgery because they had to remove an entire portion of his lung so he had to relearn how to breathe again properly afterwards using less lung volume. The only difference is his had a small plastic yellow and blue ball inside a clear plastic tube so he could visually see how he was blowing in the process, absolutely fascinating invention for sure!
That’s might have been something a little different. I think that might have been an incentive spirometer
okay, fine youtube i will watch this.... *crying as i realise i would benefit a lot from these*
I’d suggest talk to your doctor then. They should be able to help 😊
Hi Dr Gill! Thanks for this. I work in hospital pharmacy, and counselling patients on inhaler and device use is one of the more key parts of that role for me. I find that incorrect technique is extremely common and in some cases, I'd argue that better education could have prevented admissions - especially on respiratory wards.
From that point of view I feel a video going into the wider variety of different inhaler types (e.g. seebri, accuhalers, turbohalers) could be really useful. Building a culture of teaching and learning amongst our health professionals on these topics could really benefit patients. Also perhaps some suggestion of how patients and health professionals can recognise when an inhaler is failing to to it's job and a review is needed would be wonderful.
Thanks for your time! And thank you again. Take care!
Unintentional ASMR
Very clear explanation aimed at the layperson. Excellent video, thank you!
Thank you 😊
Dr, I'm kinda glad you didn't get into the RAF, because you became a Dr and bring us these excellent videos. I'm not a medical student (but do learn a lot from this channel) or one of these ASMR people, though this video does have such a hypnotic quality, I do feel like sleeping!
Well, I’m glad you’ve found them useful 😊
Thanks for being here. If you’ve any ideas for future topics that might help, please shout 😊
great results. Im 182cm my PMAX i 570(I should 620 but never done that, probably due to scoliosis). regulary I blow 540-550 when asthma is under control.
Dr. Gill i watched this video as i have to do a peak flow diary to join the RAF hopefully it all goes well due to covid i have to do it at home. good to see you went through the same steps as me
Have you been to RAF Cranwell yet?? It’s an amazing place to visit!
You, by far, have your own unique visual and linguistic ways when teaching. And excellent ways at that. But has anyone ever told you that you have the face of Jim Halpert (John Krisinski)? By no means an insult, just finally pinned who you remind me of in this particular video! Keep up all the great stuff buddy!
I’m always concerned that the way my brain works impairs my ability to teach, but it does seem to work for a small group
As for John Krisinski, I’ve always like the Jack Ryan books, so I’ll take that thanks 😊
Very informative. I’ve had asthma for almost 30 years. My yearly asthma checks ended about 15 years ago and I used to see an allergist who specialized in asthma. My gp introduced me to the peak flow meter just a few years ago. No introduction, just asked my numbers and when I didn’t have any she ordered one for me. I don’t really use it unless I’m having a flare. It’s nice to have a video with an explanation and example on how to use it correctly! I’m in the US, so instruments look at little different. What app do you recommend with the peak flow meter to monitor numbers?
Thank you!
I will Watch in its entirety, anything this man uploads
Jim from the office really has changed over the years
As a kid I always thought Doctors had unlimited health and were superhuman.
That’s *supposed* to be a secret
Unlimited health certainly wasn't true of any of the healers in the JRPG games I've played. In the middle of combat when my warriors need healed and... The doc got knocked out already!
Doctor of the Year: Dr James Gill
RAF Officer of the Year: Dr James Gill
Just got diagnosed an hour and a half ago. Ty
I hope this is helpful.
Are there other topics we could look at for you?
Literally a work of art
🤣
Dr Gill I'm 16 and don't know nothing about what your teaching but. All these videos make me want to be a doctor and I've actaully chosen biology and chemistry for my hight school main majors
Good luck 😊
If you are able, I’d suggest you get some shadowing in early so you can get an idea if you like it or now before the applications 😊
Hey Doc, I know people basically treat you as an asmr channel already but have you ever thought about creating a dedicated asmr channel before?
As an asthmatic patient I was used to those instruments. It was fun to try and challenge myself. It was hard!
I think we all do!!
I know you briefly touched on them in other videos, but I’d be interested to see allergies mentioned in a video sometime, while I’m sensitive to a lot of chemicals and things like the sun because of sensory processing disorder they aren’t the same thing as allergies exactly like my allergy to certain trees so it would be nice to see a comparison between the two like you mentioned in the celiac video!
Well, I just found out I've been using my relvar ellipta inhaler all wrong... Thank you Dr Gill! Off to review my inhaler technique.
Hope you see a benefit 😊
Thanks James that’s helpful
Very informative, thank you! I really like to understand _why_ something is done.
Thank you 😊
That “light bulb” of understanding is something I always cherish being able to help people access
Never seen these before. Interesting. Another great video Doc!
👍
Dr Gill in an alternate universe:
"Now I'm just about to conduct a carpet Bombing run over your weapons base, is that alright?"
Insurgent: "Death to America! "
Dr Gill: "😏... Excellent"
Staying on the topic of hypersensitivity, It would be great if you could cover eczema in some form for the next topic.
Perhaps not the next, but we can certainly look at that 😊
Dr Gill later found that all the inhalers were indeed NOT plecebos and that he could now breathe underwater.
🤣🤣 🐠
Dr Gill PEFR and FEV are both looking at the expiratory function but one is looking at speed and one at volume? Have I understood correctly?
Correct 👍 😊
Dr Gill in this video when you used salbutamol the peak flow increased only 4.5% . does it mean there is no reversibility as in asthma it should be 12%.
Can you also show us the peak flow diaries and how it looks in asthma please.
I think that is more of a timing effect - ie I wasn’t able to wait the whole 15mins due to still needing to complete the film 🤫
Not great, but these videos tend to be a bit time pressured
Childhood asthma similarly nobbled my chances of a career, ho hum, onwards and upwards 😊
I’m not one to knock it. I seem to have made a career out of failing upwards!
@@DrJamesGill not many have Doctor as a fall back career 🤣. My son is currently looking into becoming a RAF physiotherapist, but he needs to be assessed regarding a nut allergy - a few years ago that would've been a blanket "no" at any hint of anaphylaxis so there's a bit of light at the end of the tunnel, although I'm still not sure his chances are very good as I can't imagine they will take any chances.
Yes they have been very “absolutely no” in the past for lots of what the rest of the world considered relatively mild issues
I was utterly devastated in primary school when I learned that asthmatics couldn't be astronauts. Not sure if that's still a policy, because I'm going back to the 1980s on that... also, to be fair, my lack of science and physics skills didn't exactly keep that career path open either!
🤣🤣 I love the IDEA of space. But I think the reality is quite different from what we get told
Dr James grill what cause tremors at young 27 age. Small tremors can lack of nutrition cause tremors and vitamin d? What is best doctor specializes tremors? Which doctor is best Md. Pa, nurse practitioners thank you
I'd advise to speak your GP
Great video on peakflow. I check my peakflow twice a day. Can you replace the mouthpiece. Fostair is best steroid inhaler
Mouth piece doesn’t really need replacement for a personal meter - unless it is broken
In clinic we use disposable mouth pieces
If a person without asthma used an asthma inhaler for a week or two, would their peak flow increase anyway?
good people, we are talking about some chronic diseases that have nothing to do with the toys and the diseases of the year, there are millions of people who do not breathe even 400 and that does not mean that they have an incurable disease
How can you clean the mini wright peak flow meter and do you clean the whole meter.
You shouldn’t really need to - and in an ideal world a patient would be provided with a new peak flow meter every year
@@DrJamesGill thank you.
Excellent video, Dr. Gill!
👍
Is this why swimming/exercise are so beneficial for asthmatics, because it essentially forces our lungs to push air more forcefully, more regularly? Similar to our preventers, perhaps? I read somewhere that the preventers basically keep our airways dilated/open so that we start with a bigger 'straw' when the asthma attack narrows the tube.
Like you, my asthma all but disappeared in my teens and 20s, but now at 41, it's rearing its ugly head again; I've got an asthma plan again for the first time in years, ha.
That’s certainly now the preventers have an effect.
As for swimming, I *think* it is due to helping develop the respiratory muscles due to the forces of breathing in and out when swimming
@@DrJamesGill Ah, that makes sense too.
Several people have commented similarly, I think I’m going to have to tile my sleeves up and do an “understanding the spirometer” video
Nobody going to mention Dr Gills fashion?! 😎
My dad got diagnosed with COPD as he is two years of cigarettes from being on them for 30 years, is this basically the same concept?
Similar. But COPD is an fixed obstructive issue. Whereas asthma is a reversible
When will they make ventolin available over the counter doctors are very tite with them
Hopefully never. It’s very important that if you need more you speak to your GP and get an adequate respiratory review
Random but I really like his vest!
I’ve missed wearing “proper” clothes at work rather than scrubs
nice intro and demonstration and sacrifice of taking puffs of salbutamol within this short amount of time... wait.... at 10:11 u got me!
Top man
We agree and know that asthma can be triggered by certain things even stress.
Today you are feeling relaxed and well. Breathing is normal/ok.
You do this peak flow test and its norma(ish) for your age.
Does that then mean you dont have asthma? Does it mean you should not be prescribed an inhaler?
What if the next day something happened, you got really stressed, it triggered your asthma, you collapsed and had no inhaler?
Are you going to cover gastrocolic reflex when you cover IBS
Quite likely
This is quite the timely video! As a child I contracted Pneumonia which put me in the hospital for 2 nights, and my lungs have been asthmatic ever since.
Mostly allergy and exercise induced, with a caveat for all mucus producing viruses and illnesses always going to my lungs and taking months to clear up :/ Thankfully with immunotherapy/allergy injections I haven’t had an allergy triggered episode like that in nearly 4 years. It would be my luck to try some new cardio equipment in my gym last weekend and develop a tight chest that night. I’m coughing a week later although I don’t feel like I have any shortness of breath, but my peak flow readings are a bit on the lower end of the range. Alas, what is one to do but take the long-acting inhaler and fast-acting when needed.
Personally, I prefer to use a spacer / aerochamber rather than direct to mouth delivery, since I feel like I get more out of a dosage by suspending it, and it’s not such a pain for me to store the contraption. Do you have thoughts on the better method of delivery?
I’m a big fan of spacers actually. But they are not always convenient for people
In many ways I wish I’d also filmed the spacer
Dr. James Gill, I have exertional asthma aswell. Is there any other way than the inhaler to deal with it?
Careful training might help. Certainly thinking about the environment, to avoiding pollution, and cold as good examples
Hello doctor Gill
Thank you for the video. Can I please ask what app it was which you were using?
Thank you.
MDCalc. They also have a free website. Very useful
www.mdcalc.com/estimated-expected-peak-expiratory-flow-peak-flow
@@DrJamesGill thank you so much for the information, doctor. I was very impressed with the demonstration of it. Take care.
You are welcome. I hope it was useful.
My blow was 270 this morning, is that bad? It’s never over 300.
Depends on who you are - each person needs to have their own predicted, peak expiratory, flow values, calculated
You can do it here
www.mdcalc.com/calc/790/estimated-expected-peak-expiratory-flow-peak-flow
OK, I'm 54, an ex smoker, female and the best I could manage was 370, I'm clearly not well atol
My chest is tight now ex smoker 3years no smoking ..57years old
Not sure if I have ashma..copd or covid...my.best is 350 unless i.am doing it wrong
What was the app you used to get your calculations?
I use MDCalc.com
What would be the approximate numerical uncertainty were we to neglect the ethnicity of the person?
Honestly I do not know the answer to that.
To put it another way, we are supposed to “treat the patient, not the computer” so I would argue that if the patient still exhibits symptoms you still have work to do, regardless of the computer
I wasn’t paying attention to my youtube feed and I first thought “That’s a weird looking cannoli”
🤣🤣
4:35 you were happy with that, you're amazing :DDDD
Well, truth be told, I’ve been noticing the cough a little more when running atm, so I was surprised at the result 😊
Hi Dr. Gill. Is long term use of salbutamol ok? I've been using it for about 35 years. It's given me great relief over the years but I heard it scars the lungs with long term use. Is this true?
Safe as houses in the long term 😊
No scars, that’s not true.
In terms of use you can use it 10times back to back in extremis - although not often as that will give you temporary side effects
Dr James Gill That's a relief. Thanks for the replies. Your channel is brilliant.
👍
Thumbnail got my neurones activating.
It can... Resurface...? Well that's good to know...
As we get older, our systems so can the processes controlling them
totally different question what kind of animal is on your tie🤔
A dog or a t-rex 🤔
That should be an easy answer 😊
Which do you think?
@@DrJamesGill i think t rex🦖
Bingo 😊
Hey I used one of them on Monday when I went for my appointment. Small world.
Do you have one at home now as well to keep monitoring?
@@DrJamesGill Oh no. It was just to test my lung capacity to check there wasn't a problem with them.
Ah ok. Hope all was good then 😊
What do you think about Terbasmin Turbuhaler?
Terbutaline is another good med. Although personally I don’t like to Turbohaler as much as the alternatives
@@DrJamesGill thanks Dr Gill :-)
Excuse me sir, is that a T-REX TIE?? 😍😍
🦖 👍
Dr. Gill: When using a peak-flow meter, what can you do if patient has a HX of Bell's Palsy? I have this problem, I'm unable to form a tight mouth seal. Thank You
We would have to use a face mask instead
*why did you make that a thumbnail*
Honestly, as I needed to get that one finished quickly, and it was an easy screen grab
Wow really
Really
@@DrJamesGill
How can I do this I have really bad asthma and COPD
Speak to your GP, I’d hope nearly all asthmatics, certainly those with symptoms of asthma would have a peak flow meter at home
@@DrJamesGill I absolutely will thank you very much, they never tell people about this but I'm glad you did thank you very much this will definitely help make life a bit easier thanks to you!!
I have asked my name never use that many inhalers at one time tachycardia
??
Have to do this, and the lung volume one, for my work, really uncomfortable test
Lung volume can be unpleasant, but the PEFR shouldn’t have been a problem I would have thought?
@@DrJamesGill having to keep my mouth in that position and exhale hard isn't great.
Got my asthma under control after 20 years, but since having covid, I get wheezy a lot more after literally doing nothing! Annoying as hell
That’s annoying. Have you discussed a medication review with your GP?
@@DrJamesGill absolutely not lol, wait time is horrendous
mujhe to ye kabad me mila tha bas mujhe pata nahi tha is liye
hello dctr hope you will be doing good how can I get in touch with you?
Get here because of CZcams algorithm, stayed because the dinosaur tie.
🤣🤣🤣 everyone loves a t-Rex tie!!
Hi there. Why does the peak flow need to be less than a year old?
As the machine can deteriorate over time, repeated use, deposits from breath, genera wear and tear
It’s best to be accurate with these things, esp if it affects treatment
A difference of 10l/min could actually change what we do with a patient
@@DrJamesGill excellent! I'll have to remember to pass this information on to my pharmacist and patients!
When my daughter gets the flu, she becomes very wheezy (especially during the night) and I have a lot of trouble trying to calm her down to take her inhaler, she's 3 years old.
Are there any tips to help a young child feel a little bit more comfortable so she can take the inhaler instead of freaking out?
Love your videos 😁👍
Does she have a spacer?
@@DrJamesGill Yes she does, I think it freaks her out a bit, so she struggles to allow it to get close to her face
There are ones that don’t have a mask which can be better for the Little’s ones that don’t like the mask
@@DrJamesGill I'll have a look into it, thank you! 😁
👍
His voice is for sleep 😴 💤
Hence my students glazed faces
6:29 😂😂😂
The name's Gill. James. Gill.
Delayed by covid I’m afraid!
10:11 if that was a cut, that was smooth
When you realise you don’t have something to hand, and need to get out from the frame 🤣
Dr. Gill trying to show off how much he can exhale lol
As not so much a flex as a wheeze!
Sus thumbnail😂
10:44
From the thumbnail i thought this was a stimpee video
We test it in a water glass. If the inhaler floats, it's empty
That’s a really good idea.
Although I’m curious, is there a transition point say 90% empty where is floats, or is it pretty much floats = empty
@@DrJamesGill the glass must be almost full. When you put the inhaler in, if it touches the bottom, bouncing a bit, then it's almost over, but you still get a few sprays. If he just floats almost out of the glass, it's empty. Even if you shake it and it feels like there's something in it, it's usually just foam.
When you use it regularly, you can calculate the number of days and how many sprays you get, so you'll know when to start testing. I worked 6 years in a PICU, we did this all day lol
That’s incredibly useful. Thank you.
4:13 grrrbluugl
Not ASMR!!!
why is he whispering?
Its just the way he talks. He just has an extremely relaxing voice
how old are you?
37 - it’s important to use the patients age for the calculation
@@DrJamesGill I thought you were about 50 years old but it's ok what matters is your health right, good luck to you Dr James Gill
🧐
6:28