Characteristics and Prognostic Value of Morning Dipping of Peak Expiratory Flow Rate in Stable Asthmatic Subjects

Bellia, Vincenzo; Cibella, Fabio; Migliara, G.; Peralta, G.; Bonsignore, G

doi:10.1378/chest.88.1.89

Cited by 21 publications

(6 citation statements)

References 20 publications

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“…Asthma and Morning Dipping of PEF ing patients'. This is supported by two other studies [7,22], Bellia et al [9] found only slight differences between the different patient groups.…”

Section: Discussionsupporting

confidence: 83%

“…Otherwise, the frequency of nocturnal waking was the same in 'morning-dipping patients' and 'remaining patients'. In the study by Bellia et al [9] there was also no difference in nocturnal waking between pa tients with or without morning dipping. From these find ings it might be concluded that nocturnal waking is not merely the consequence of more severe nocturnal bronchoconstriction or more severe asthma in general.…”

Section: Discussionmentioning

confidence: 80%

“…A general problem in determining the rate of occur rence and of patient characteristics among patients with morning dipping and nocturnal asthma is the fact that these features can wax and wane over time even in stable conditions [9].…”

Section: Discussionmentioning

confidence: 99%

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Nocturnal Waking and Morning Dip of Peak Expiratory Flow in Clinically Stable Asthma Patients during Treatment

Keimpema

Ariaansz²,

Tamminga³

et al. 1997

Respiration

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The occurrence of nocturnal waking due to asthma and morning dip of the peak expiratory flow (PEF), and the associated patient characteristics were investigated in 103 clinically stable asthmatic patients from a pulmonary outpatient clinic. Analysis of a 1 week diary showed a mean week morning PEF dip (i.e. morning/daytime highest PEF) of 12%. A mean dip of ≥20% was found in 20% of the patients. Three groups were distinguished: 10% were ‘nocturnal-waking patients’ (waking up > 2 nights a week with a PEF dip of > 20%); 19% ‘morning-dipping patients’ (patients with > 3 dips a week of ≥20% but with waking up on < 2 nights a week) leaving 71% ‘remaining patients’. 28% of all patients showed morning PEF dips. In a questionnaire, waking every night was reported by 9%, at least once a week by 42% and once a month by 72%. In ‘nocturnal-waking patients’ FEV₁ and morning and evening PEFs were lower than in ‘remaining patients’; complaints during the night and on rising were more severe. The morning PEF dip was the same in ‘nocturnal-waking patients’ and ‘morning-dipping patients’. The occurrence of waking was the same in ‘morning-dipping patients’ and in the ‘remaining patients’. There were no differences in other clinical parameters among the three groups. We conclude that a subset of clinically stable asthma patients presents morning dips and nocturnal waking. They do not differ substantially from the remaining patients in other clinical characteristics.

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“…Asthma and Morning Dipping of PEF ing patients'. This is supported by two other studies [7,22], Bellia et al [9] found only slight differences between the different patient groups.…”

Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 80%

See 1 more Smart Citation

Nocturnal Waking and Morning Dip of Peak Expiratory Flow in Clinically Stable Asthma Patients during Treatment

Keimpema

Ariaansz²,

Tamminga³

et al. 1997

Respiration

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“…In several studies, the change in diurnal variation over time, even if significantly related to other parameters has been very small [47, 48]and in others it has been insignificant [17, 38, 49]. A large Dutch step-up study in which an inhaled corticosteroid was added to treatment changes in PEF variation showed poor concordance with other parameters of asthma severity, and the authors concluded that home recording of PEF alone may not be sufficient to monitor asthma reliably [50].…”

Section: Measurement Of Lung Function Day-to-day Variationmentioning

confidence: 99%

Monitoring Asthma Severity and Response to Treatment

Godfrey

2001

Respiration

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Guidelines for the management of asthma rely on various methods of assessing severity and how it changes in order to select the appropriate treatment. These methods have been developed from the basic clinical skills of history taking and physical examination to which attempts at improving objectivity have been added, such as the use of asthma diaries, the home recording of peak expiratory flow (PEF) or measurements of bronchial reactivity. The present review was an attempt to determine to what extent monitoring asthma by various techniques is justified. Unfortunately, diaries and home recording of PEF are easily faked and generally unreliable while objective tests, such as the measurement of bronchial reactivity or studies of induced sputum cannot be undertaken often enough for monitoring, and there is certainly the need for prospective longitudinal controlled studies.

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“…Though monitoring peak flow can be useful to assess patients and inform management (III), the routine home use of peak flow methers does not alter patient outcomes (I) 6. Morning “dipping” of peak flow values reflects transient rather than long term poor control (II) 7. Additionally, in acute situations peak flow can be used to predict outcome (III) 8…”

Section: Peak Flow: Diagnosis and Management Recommendationsmentioning

confidence: 99%

North of England evidence based guidelines development project: summary version of evidence based guideline for the primary care management of asthma in adults

1996

BMJ

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Characteristics and Prognostic Value of Morning Dipping of Peak Expiratory Flow Rate in Stable Asthmatic Subjects

Cited by 21 publications

References 20 publications

Nocturnal Waking and Morning Dip of Peak Expiratory Flow in Clinically Stable Asthma Patients during Treatment

Nocturnal Waking and Morning Dip of Peak Expiratory Flow in Clinically Stable Asthma Patients during Treatment

Monitoring Asthma Severity and Response to Treatment

North of England evidence based guidelines development project: summary version of evidence based guideline for the primary care management of asthma in adults

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