Letters to the Editor
Respiratory Arrest After Peak Expiratory Flow Measurement
FREE PREVIEW Log in or buy this issue to read the full article. AAFP members and paid subscribers get free access to all articles. Subscribe now.
FREE PREVIEW Subscribe or buy this issue. AAFP members and paid subscribers get free access to all articles.
Am Fam Physician. 1998 Sep 1;58(3):662-663.
to the editor: Peak expiratory flow is a convenient tool for following and assessing patients with asthma. Patients are instructed in peak expiratory flow measurement as a means of home monitoring and adjustment of therapy, and it is considered to be safe, inexpensive and effective. However, at least two deaths caused by respiratory arrest following measurement of peak expiratory flow have been reported in young patients,1 both of which occurred during an acute asthmatic attack. We recently saw a patient suffer respiratory arrest in the office following measurement of peak expiratory flow; however, the patient was not having an acute asthmatic attack at the time, but was instead in the office for a routine follow-up visit.
The patient, a 41-year-old man, is well known in our office. Almost 10 years earlier, he was treated for a positive purified protein derivative test with six months of isoniazid therapy, but he has no other medical problems besides asthma. He was in the office for routine follow-up and adjustment of medications. His vital signs were blood pressure 110/79 mm Hg, pulse rate 76 per minute and oxygen saturation 90 percent on room air. He was doing well, in fact better than his usual baseline, and his physician measured his peak expiratory flow in the office. It was 300 mL, significantly better than his usual measurements. She stepped out of the examination room to verify dosages of medication, when she heard him call for help. She immediately returned to the examination room where she witnessed the patient suffering respiratory arrest and progressing to cardiac arrest. Cardiopulmonary resuscitation, including chest compressions and medications, was required to resuscitate him. He was transferred to the intensive care unit, where he did well, and was subsequently discharged without sequelae.
We would caution physicians to be aware that measurement of peak expiratory flow, although generally considered safe, can trigger bronchospasm and the complications of respiratory or cardiac arrest.
1. Lemarchand P, Labrune S, Herer B, Huchon GJ. Cardiorespiratory arrest following peak expiratory flow measurement during attack of asthma. Chest. 1991;100:1168–9.
Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: email@example.com, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.
Please include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.
Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the American Academy of Family Physicians permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.
Copyright © 1998 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact firstname.lastname@example.org for copyright questions and/or permission requests.
Want to use this article elsewhere? Get Permissions