 With the tracheostomy cuff inflated, the peak expiratory flow meter will be attached directly to the tracheostomy tube. The patient will be instructed to take as big a breath as they can and then forcefully cough. This will be repeated four times. The first measurement will be discarded learning curve. The peak expiratory flow will be recorded for the next three measurements. The three measurements should not deviate by more than 10, and the best result will be recorded. 