Peak Flow

Peak Flow

LASA filenames:

Contact: Natasja van Schoor


The peak expiratory flow rate (PEFR, also known as peak flow) is defined as a person’s maximum speed of expiration. PEFR primarily reflects large airway flow and depends on the amount of airway obstruction, the voluntary effort and muscular strength of the patient. PEFR demonstrates a high intra-individual variation and a diurnal rhythm (1;2).

Measurement instruments in LASA

PEFR was measured using the Mini-Wright peak flow meter in 1995/96, 1998/99, 2001/02, 2008/09 and 2011/12. All subjects received an instruction about the use of the peak flow meter. For the measurements, the subjects were asked to take a maximum inspiration and to breath out with maximum effort into the peak flow meter. The highest score of three measurements was used in the analyses (3;4). A learning effect may play a role in the performance of the measurements. Therefore, if only one successful measurement is available in an individual, it may be decided to exclude this individual from analyses because the available measurement may be an underestimation of the real peak flow in that individual.


LASAB158 / LASAC158 / LASAD158 / LASAE158 / LASAG158 / LASAH158 (medical interview, in Dutch)

Variable information

LASAB158 / LASAC158 / LASAD158 /LASAE158 / LASAG158 / LASAH158

Availability of information per wave


Peak Expiratory Flow rate


¹ More information about the LASA data collection waves is available here.

* 2B=baseline second cohort;
3B=baseline third cohort (measurement by spirometry);
MB=migrants: baseline first cohort;
K=future wave 2021-2022

Me=data was collected in medical interview

Previous use in LASA

In LASA, serum 25-hydroxyvitamin D (25-OH)D was related to PEFR in older men, but not in older women (Van Schoor et al. 2012). Because pulmonary function depends on muscle function, the mediating effects of muscle strength and physical performance were examined. It appeared that the observed association in men was partly explained by physical performance and muscle strength. In another LASA study, PEFR was selected as a proxy for muscle strength, and used as a marker for frailty (Puts et al. 2005). Other research used PEFR as indicator of mobility-related physical limitations (MOBLI), exploring differences in thresholds for reporting mobility disability (Melzer et al. 2004). The MOBLI index is found to be responsive to changes in self-reported mobility disability over two 3-year periods (Lan et al. 2003).

  • Duggan EC, Piccinin AM, Clouston S et al. A Multi-study Coordinated Meta-analysis of Pulmonary Function and Cognition in Aging. J Gerontol Med Sci 2019; 74: 1793-1804.
  • Eekhoff EMW, Van Schoor NM, Biedermann JS, Oosterwerff MM, De Jongh RT, Bravenboer N, van Poppel MNM, Deeg DJH. Relative importance of four functional measures as predictors of 15-year mortality in the older Dutch population. BMC Geriatr 2019; 19: 92.
  • Lan TY, Deeg DJ, Guralnik JM, Melzer D. Responsiveness of the index of mobility limitation: comparison with gait speed alone in the longitudinal aging study amsterdam. J Gerontol A Biol Sci Med Sci 2003; 58(8):721-727.
  • Melzer D, Lan TY, Tom BD, Deeg DJ, Guralnik JM. Variation in thresholds for reporting mobility disability between national population subgroups and studies. J Gerontol A Biol Sci Med Sci 2004; 59(12):1295-1303.
  • Puts MT, Lips P, Deeg DJ. Sex differences in the risk of frailty for mortality independent of disability and chronic diseases. J Am Geriatr Soc 2005; 53(1):40-47.
  • Van Schoor NM, de Jongh RT, Daniels JM, Heymans MW, Deeg DJ, Lips P. Peak Expiratory Flow Rate Shows a Gender-Specific Association with Vitamin D Deficiency. J Clin Endocrinol Metabolism 2012; 97, 6, 2164-2171.


  1. Hegewald MJ, Crapo RO, Jensen RL. Intraindividual peak flow variability. Chest 1995; 107(1):156-161.
  2. Goyal M, Goel A, Kumar P, Bajpai M, Verma NS, Kant S, Tiwari S. Circadian rhythm of peak expiratory flow rate in healthy north Indian men. Indian J Physiol Pharmacol 2008; 52(1):64-68.
  3. Cook NR, Evans DA, Scherr PA, Speizer FE, Vedal S, Branch LG, Huntley JC, Hennekens CH, Taylor JO. Peak expiratory flow rate in an elderly population. Am J Epidemiol 1989; 130(1):66-78.
  4. van Schoor NM, de Jongh RT, Daniels JM, Heymans MW, Deeg DJ, Lips P. Peak Expiratory Flow Rate Shows a Gender-Specific Association with Vitamin D Deficiency. J Clin Endocrinol Metabolism 2012, 97, 6, 2164-2171.

Date of last update: April, 2020 (EH)