title: Effect of altitude on spirometric parameters and the performance of peak flow meters.
abstract: BACKGROUND
  Portable peak flow meters are used in clinical practice for measurement of peak expiratory flow (PEF) at many different altitudes throughout the world. Some PEF meters are affected by gas density. This study was undertaken to establish which type of meter is best for use above sea level and to determine changes in spirometric measurements at altitude.
  
  
  METHODS
  The variable orifice mini-Wright peak flow meter was compared with the fixed orifice Micro Medical Microplus turbine microspirometer at sea level and at Everest Base Camp (5300 m). Fifty one members of the 1994 British Mount Everest Medical Expedition were studied (age range, 19-55).
  
  
  RESULTS
  Mean forced vital capacity (FVC) fell by 5% and PEF rose by 25.5%. However, PEF recorded with the mini-Wright peak flow meter underestimated PEF by 31%, giving readings 6.6% below sea level values. FVC was lowest in the mornings and did not improve significantly with acclimatisation. Lower PEF values were observed on morning readings and were associated with higher acute mountain sickness scores, although the latter may reflect decreased effort in those with acute mountain sickness. There was no change in forced expiratory volume in one second (FEV1) at altitude when measured with the turbine microspirometer.
  
  
  CONCLUSIONS
  The cause of the fall in FVC at 5300 m is unknown but may be attributed to changes in lung blood volume, interstitial lung oedema, or early airways closure. Variable orifice peak flow meters grossly underestimate PEF at altitude and fixed orifice devices are therefore preferable where accurate PEF measurements are required above sea level.
authors.affiliation: British Mount Everest Medical Expedition.
authors.forename: A J
authors.initials: AJ
authors.lastname: Pollard
authors.forename: N P
authors.initials: NP
authors.lastname: Mason
authors.forename: P W
authors.initials: PW
authors.lastname: Barry
authors.forename: R C
authors.initials: RC
authors.lastname: Pollard
authors.forename: D J
authors.initials: DJ
authors.lastname: Collier
authors.forename: R S
authors.initials: RS
authors.lastname: Fraser
authors.forename: M R
authors.initials: MR
authors.lastname: Miller
authors.forename: J S
authors.initials: JS
authors.lastname: Milledge
mesh_terms: D000328:Adult; D000531:Altitude; D000532:Altitude Sickness / Q000503:physiopathology; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009051:Mountaineering / Q000502:physiology; D010366:Peak Expiratory Flow Rate; D012119:Respiration / Q000502:physiology*; D012129:Respiratory Function Tests; D013147:Spirometry / Q000295:instrumentation*; D013997:Time Factors; D014797:Vital Capacity