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Main > Asthma Center > Peak Flows

Peak Flows

A peak flow meter is an important tool to help manage asthma and which can help us to determine how your child is doing. Most children are able to use a peak flow meter once they are five to six years old. You can discuss with your pediatrician if your child should be monitoring peak flows at home.

Your child's peak flows represent how much air he can get out of his lungs. By monitoring his peak flows on a daily basis, you will know what to do when he has an asthma attack and may even be able to predict and prevent them. You Pediatrician will also probably check your child's peak flows during office visits.

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It is best to check your child's peak flows two or three times a day and keep a diary of them on your peak flow calendar, especially until his asthma is under good control. Regularly monitoring peak flows will allow you to track changes in his peak flows over time. For many kids, their peak flows will begin to drop just before they are going to have an acute attack, even before they begin to have symptoms, so if you are checking peak flows every day you may catch an asthma attack early or even predict when an attack is about to start. Starting his treatments early according to his asthma action plan may help to prevent a severe asthma attack.

Regular peak flow monitoring can also help to determine if your Pediatrician needs to change your child's daily medications, and they can be used to help determine when to stop or decrease a medication or when to begin or increase a medication.

Monitoring peak flows on a regular basis may also help you to identify triggers that make your child's asthma worse. If you notice that his peak flows drop every time that he is around cats, then you will know that cats are a trigger for his asthma and you will know to avoid them in the future.

Once your determine your child's personal best peak flow (see below), we can use this number to help determine his peak flow zones. These zones are grouped into a green zone, which is 80-100% of his personal best, yellow zone, which is 50-80% of his personal best, and red zone, which is below 50% of his personal best. If your child's peak flows vary greatly from day to day, especially if they often dip down into his yellow or red zone, then this may be a sign that his asthma isn't under very good control and you should see your Pediatrician to talk about it.

The green zone is where your child should be everyday. This means his asthma is under good control and he is not having any symptoms. You should continue to use your daily medications according to your asthma treatment plan, but he shouldn't need to use a short acting bronchodilator medicine (unless it is for preventing exercise induced asthma).

When your child begins to have symptoms with his asthma, then he may move into his yellow zone (50-80% of his personal best peak flow). He may begin coughing, wheezing, have a tight chest, shortness of breath, have difficulty performing his normal activities, and he may wake up at night coughing. This is a cautionary zone that your child should not be in every day. You should begin using your bronchodilator medicine according to your asthma action plan. Your doctor may also have you increased the amount of inhaled steroid that you are on when you are in your yellow zone.

If your child's peak flows are less than 50% of his personal best, then he is in the red zone, which is a danger zone that indicates that your child's asthma is worsening. You should use your bronchodilator medicine right away and call your physician. When in the red zone, your child may be breathing hard and fast, have constant coughing, have difficulty talking or walking, and his ribs may be showing when he breathes.

An alternative method of calculating peak flow zones used by some physicians is a green zone between 90-100% of a personal best peak flow, high yellow zone between 70-90% of a personal best, low yellow zone between 50-70% of a personal best, and a red zone below 50% of a personal best.


Using a Peak Flow Meter

  • Move the pointer to zero.
  • Stand and take the deepest breath that you can.
  • Put the mouthpiece of the meter in your mouth and seal your lips around it.
  • Be sure that he does not cover the opening at the end of the tube, as this can artificially raise his peak flow.
  • Blow out into the mouth piece as hard and fast as you can.
  • Read the meter.
  • Repeat these steps 3 times and record the best out of the 3 tries.
  • Clean your peak flow meter according to the manufacturer's instructions.

Personal Best Peak Flow

You can determine your child's personal best peak flow by having him use his peak flow meter 2-3 times on a day for a week or two when his asthma is under very good control.

You may have to practice for a few weeks until he learns good technique and is able to generate a real peak flow. If he is using poor technique, such as not blowing out completely, not getting a tight seal, etc, then his peak flow will be artificially low. It takes most children a few weeks to get the hang of using a peak flow meter.

If your child's personal best peak flow is consistently below 80% of what his predicted peak flow should be, then your Pediatrician may consider using a short coarse of an oral steroid to see if his lung function can be improved.


Predicted Peak Flow

We can also use your child's height to help determine a predicted peak flow. This value is the average peak flow for children of the same height. Depending on your child, his predicted peak flow may be much higher or lower than his usual or best peak flow. If possible, it is probably better to determine your child's personal best peak flow, and use that number instead of his predicted peak flow to figure out his peak flow zones for his asthma action plan.

Exercise Induced Asthma

Monitoring peak flows can also be helpful for diagnosis and monitoring exercise induced asthma symptoms. You should check his peak flow before he begins exercising and about 5-10 minutes after he has been exercising vigorously. You can also check it at the beginning of his first rest period and 15-30 minutes after he has finished exercising. If there is much of a difference between the peak flows before and during exercise then he may have exercise induced asthma. If he develops symptoms, such as a cough, difficulty breathing or wheezing, then you can check his peak flow again, use your bronchodilator, and allow him to rest.


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American Academy of Pediatrics Guide to Your Child's Allergies and Asthma : Breathing Easy and Bringing Up Healthy, Active Children

The Asthma Sourcebook : Everything You Need to Know


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Important disclaimer: The information on keepkidshealthy.com is for educational purposes only and should not be considered to be medical advice. It is not meant to replace the advice of the physician who cares for your child. All medical advice and information should be considered to be incomplete without a physical exam, which is not possible without a visit to your doctor.