1. As with describing inhaler technique, this station tests your knowledge of asthma as well as your knowledge of peak expiratory flow rate measurement and your ability to communicate with patients.

2. Firstly, it is good to check the patient's understanding of their condition. If they do not understand fully you should explain what is happening and that when they have an exacerbation they find breathing more difficult. Furthermore, you should explain why measuring their PEFR is an important as a guide to how well controlled their asthma is at that time.

3. Explain to the patient that they should be checking their PEFR regularly, particularly if their asthma is worse than usual.

4. Start by describing the different steps in PEFR measurement to the patient. These are:

• Connect a clean mouthpiece.
• Ensure the marker is set to zero.
• Stand up or sit upright.
• Take as deep a breath in as you can and hold it.
• Place the mouthpiece in your mouth and form as tight a seal as possible around it with your lips.
• Breathe out as hard as you can.
• Observe and record the reading.
• Repeat the process 3-4 times and record the highest reading.
• Note down the reading in a diary to allow comparison with readings on other days.

5. Once you have discussed through the process, you should show the patient how to perform the measurement. Do this by measuring your own PEFR.

6. Once you have done this you should ask the patient to show you how they would perform the measurement. Make sure that they are doing this correctly and correct any mistakes which they might be making.

7. Finish by asking the patient if they have any questions or concerns about either their asthma or the PEFR measurement.

© Matthew Green and Laura Henderson 2006.