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Background: Chronic respiratory diseases, including asthma and chronic obstructive pulmonary disease (COPD), are among the most common non-communicable diseases globally and contribute substantially to morbidity, mortality, and health system costs. In asthma and COPD management, objective assessment of lung function is essential for diagnosis, monitoring exacerbations, and guiding therapy. Asthma and COPD are rising causes of morbidity and mortality in Ghana, yet objective tools for monitoring airflow limitation remain underused. Peak flow meters (PFMs) offer a simple, low-cost method for assessing airway obstruction, but their utilisation by nurses has not been well documented. Objective: The primary objective of this study is to assess nurses’ knowledge, practices, and perceived barriers to PFM utilisation in the management of respiratory disorders at Komfo Anokye Teaching Hospital (KATH), Ghana. Methods: A descriptive cross-sectional survey was conducted among 335 registered nurses selected through proportionate stratified sampling from medical, surgical, and emergency units of KATH. Data were collected using a pretested structured questionnaire. The instrument comprised four sections: demographic characteristics (age, sex, rank, years of practice, unit of work); knowledge of PFM use (purpose, calibration units, colour zones, clinical indications); practice of PFM use (experience, patient instruction, documentation); and perceived barriers to PFM utilisation. All the collected data were analysed with descriptive statistics (SPSS version 26). Results: Knowledge of PFM use was poor, as only 55 nurses (16.4%) correctly identified the PFM as a device for measuring airflow limitation, and 28 (8.4%) recognised litres per minute as the standard calibration unit. Across the seven scored knowledge items, the estimated mean correct score was 2.36 ± 0.9 (out of 7), reflecting limited knowledge overall. Practical use was similarly limited, with 93 (27.8%) reporting ever using a PFM to assess a patient and 20 (6.0%) documenting peak flow values after bronchodilator administration. Major barriers included work overload (329, 98.2%), high device cost (315, 94.0%), lack of time to teach patients (305, 91.0%), and administrative unavailability of PFMs (304, 90.7%). Conclusion: Nurses at KATH demonstrated substantial gaps in both knowledge and practice of PFM use despite acknowledging its clinical importance. Integrating PFM training into pre-service nursing curricula, providing regular in-service education, and ensuring consistent device availability are critical to strengthening respiratory care in Ghana. This study is limited by its cross-sectional design and single-site setting, which constrain generalizability. Future research should therefore involve multiple centres, include observational or audit data on PFM use, and examine both the effects of structured training interventions and the contextual factors influencing PFM utilisation in different clinical areas.