A Randomized Clinical Trial of Peak Flow versus Symptom Monitoring in Older Adults with Asthma

Abstract

Objective: To determine whether peak flow monitoring has value above and beyond symptom monitoring when used as part of an asthma management plan. Methods: From a large managed-care organization, 296 adults, aged 50-92 yr, were recruited and randomly assigned in equal numbers to either use of symptoms or peak flow rate (twice daily or "as needed") for asthma monitoring, and monitored every 6 mo for 2 yr. Interventions were delivered in four 90-min small-group classes and included a personalized action plan and coaching in proper use of asthma inhalers. Results: We found no significant differences between peak flow rate and symptom monitoring, or between twice-daily and as-needed peak flow monitoring in the primary or secondary study outcomes: health care utilization (acute, nonacute, or total asthma visits), Asthma Quality-of-Life Questionnaire (AQLQ) scores, and lung function. AQLQ scores and prebronchodilator FEV 1 increased significantly for both groups between baseline and 6 mo (AQLQ: mean, 0.4 units; 95% confidence interval, 0.3, 0.5; p Ͻ 0.0001; FEV 1 % predicted: mean, 4%). Inhaler technique improved substantially in both groups. Conclusions: Peak flow monitoring has no advantage over symptom monitoring as an asthma management strategy for older adults with moderate-severe asthma when used in a comprehensive asthma management program. Improved outcomes in both groups suggest that understanding proper medication use, regular monitoring of asthma status, and understanding how to respond to changes are of primary importance.

Home telemonitoring (forced expiratory volume in 1 s) in children with severe asthma does not reduce exacerbations

“…Clear modifications of peak expiratory flow are not necessarily associated with any alteration in FEV1, and exacerbations of asthma are observed without any change in peak expiratory flow [14]. Studies do not support the hypothesis that routine peak expiratory flow monitoring is better than monitoring of overall symptoms as an asthma self-management plan, either in adults or in children [3][4][5].…”

“…High healthcare use, including hospitalisation, is a characteristic of these patients [2]. The addition of home peak expiratory flow monitoring to a symptom-based self-management plan does not improve asthma outcome [3][4][5]. Preliminary studies have demonstrated the feasibility of using a spirometer or peak flow meter and recording data, which are transferred via telephone or internet to medical personnel.…”

Ten-Year Follow-Up of Early Intensive Self-Management Guidance in Newly Diagnosed Patients with Asthma

“…Beasley (9) was the first to teach patients how to adjust their ICS doses according to their peak expiratory flow (PEF) measurements. However, later studies in which PEF and symptom-based self-management programs have been compared have shown controversial results (10). Selfmanagement training programs introduced in specialist clinics have been shown to be effective in the short *Correspondence author: Jouni Hedman, M.D., Ph.D., Department of Pulmonary Diseases, South Karelia Central Hospital, Valto Käkelän katu 1, 53130 Lappeenranta, Finland; Fax: +358 5352 5895; E-mail: jouni.hedman@pp1.inet.fi term (11)(12)(13)(14), but the long-term results are inconsistent, depending on the primary outcomes (15)(16).…”

Épreuves fonctionnelles respiratoires dans l’asthme réfractaire

“…Cette mesure du DEP peut ê tre ré alisé e avec un dé bitmè tre classique ou avec un dé bitmè tre é lectronique [22]. Gautrin [24]. Le DEP reste toutefois un outil important dans la prise en charge de l'asthme puisqu'il permet de dé pister les patients qui ont une mauvaise perception de l'obstruction bronchique ou de la dyspné e, objectivé e chez 1 patient asthmatique sur 4 [25].…”