Compliance with and accuracy of daily self-assessment of peak expiratory flows (PEF) in asthmatic subjects over a three month period

Verschelden, P; Cartier, André; L’Archevêque, Jocelyne; Trudeau, Carole; Malo, Jean‐Luc

doi:10.1183/09031936.96.09050880

Cited by 114 publications

(87 citation statements)

References 24 publications

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“…Also, small but significant intercorrelations between aeroallergens and air pollutants were found in the present study ( Outcome misclassification in diary studies is an additional source of error due to a lack of truly verifiable patient data. This can occur through a lack of subject compliance (invalid PEFR maneuvers, falsified records, and distant recall), an issue that has plagued asthma diary studies to the present (39,40). Data quality could be greatly improved by the use of subnotebook diaries, nebulizer chronologs, and forced expiratory volume in 1 sec (FEV1)/PEFR monitors that are electronic and time-date stamped, but these alternatives are costly.…”

Section: Resultsmentioning

confidence: 99%

The Effect of Outdoor Fungal Spore Concentrations on Daily Asthma Severity

Delfino¹,

Zeiger²,

Seltzer³

et al. 1997

Environmental Health Perspectives

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The relationship between day-to-dy changes The present study was designed to investigate the potential interactive and independent effects of ozone (03) and outdoor aeroallergens (pollens and molds) on daily asthma severity. This was carried out using the panel study design, which is characterized by longitudinal analyses of daily data for a panel of asthmatics, with each subject acting as his or her own control. This study was conducted in the small Southern California community of Alpine, California, over an 8-week period from 9 May through 3 July 1994. The time period was selected to maximize both 03 and fungal spore exposures, and followed the peak spring pollen season for the area. This study represents

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Section: Resultsmentioning

confidence: 99%

The Effect of Outdoor Fungal Spore Concentrations on Daily Asthma Severity

Delfino¹,

Zeiger²,

Seltzer³

et al. 1997

Environmental Health Perspectives

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“…25,29 However, our results are in striking disagreement with other studies of stable chronic asthma patients or with expert trialists, which indicated that adherence was generally poor and worsened during prolonged monitoring, and that falsification was rampant. 28,30 Also, we found that adherence was consistently higher for symptom score than for PEF (see Table 3): 82% of the patients had Ն 75% adherence with symptom score, but only 73% with PEF.…”

Section: Adherencementioning

confidence: 70%

“…Moreover, a substantial 22% of the entered values were fabricated. 28 However, the fact that the patients were clinically stable might have reduced their motivation to adhere to a method that, as in our setting, may have been perceived by patients with poorly controlled asthma as instrumental in gaining clinical improvement.…”

Section: Adherencementioning

confidence: 99%

Retrospective Monitoring in the Management of Persistent Asthma

et al. 2011

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BACKGROUND: There is still considerable disagreement on several aspects of monitoring asthma with symptom score and peak expiratory flow (PEF). OBJECTIVE: To investigate patient adherence to a retrospective diary-card monitoring method in patients with poorly controlled persistent asthma, in a clinical management setting; to develop improved methods for fast manual entry data into a computer; and to generate real-time informative graphs of the data. METHODS: In 115 consecutive adult patients we applied a diary-card monitoring method in which the patient records symptom score and PEF. We analyzed the diary cards of 84 patients. We used SigmaPlot software to graph the data, and linear regression to analyze the relationship between days of expected diary-card completion and days of actual correct diary-card completion (completed entries). RE-SULTS: Linear regression gave an overall correlation coefficient (r 2 ) of 0.65. Surprisingly, the r 2 values in the patients with mild, moderate, and severe asthma were 0.24, 0.44, and 0.99, respectively, revealing a striking correlation between adherence and severity. Moreover, when we arbitrarily set 75% as the minimum acceptable rate of days of completed diary-card entries, 68% of the patients were in the over-75% category. Remarkably, 100% of the patients with severe asthma were above the 75% cut-off. The graphing method we tested proved user-friendly, flexible, and quick, allowing computerized processing of 30 days of data sets in 5 min, and generation of high-quality selfexplanatory graphs that facilitate rapid management decision making via visual pattern recognition. CONCLUSIONS: In a clinical setting, retrospective monitoring of patients with moderate and severe persistent asthma by symptom score and PEF is feasible, and patient adherence appears to be good, particularly in patients with severe asthma. We recommend a lower priority on retrospective monitoring in patients with mild persistent asthma. Monitoring should be carried out according to a definite follow-up protocol. Improving the quality and standardization of the monitoring graph is a priority.

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“…In the clinical setting, several studies have shown that both occupational and nonoccupational asthmatics falsify a large percentage (20-50%) of reported measurements [45,46]. The compliance tended to decrease with time, reaching a plateau after 1 month.…”

Section: Compliancementioning

confidence: 99%

Questionnaires, spirometry and PEF monitoring in epidemiological studies on elderly respiratory patients

Bellia¹,

Pistelli²,

Giannini³

et al. 2003

Eur Respir J

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Questionnaires are the most used subjective instrument of measurement in respiratory epidemiology. The standardisation of the questionnaires aims to limit bias by maximising validity and reliability, and comparability. Within the European Union project BIOMED1, a compendium of respiratory standard questionnaires (CORSQ) was developed for adults covering 18 topics from general information to early life events, through environmental risk factors and respiratory symptoms and diseases.Reliable spirometry data needs a rigorous quality control programme, as in the "Salute Respiratoria nell9Anziano" (Sa.R.A.) project, Italian for "Respiratory Health in the Elderly". Reproducibility rates were 95.8% for forced expiratory volume in one second (FEV1). Male sex and age were independent risk factors for a poorer reproducibility, as well as cognitive and physical impairment (shorter 6-min walking distance) and lower educational level for a poorer acceptability. Reference values for people aged 65-85 yrs have been produced; these results suggest that the effect of aging should be corrected for physical and mental disability. A revision of interpretative strategies included in current guidelines is needed.Peak expiratory flow monitoring has several methodological problems: reliability and sensitivity of the measurement in order to detect changes in airway calibre; compliance with long-term monitoring; choice of the best variability index; difference between asthmatic and nonasthmatic subjects; age-related differences. Despite these methodological problems, peak expiratory flow monitoring has been successfully used in the evaluation of the effects of air pollution in normal and asthmatic subjects, and in the elderly. Eur Respir J 2003; 21: Suppl. 40, 21s-27s.

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Compliance with and accuracy of daily self-assessment of peak expiratory flows (PEF) in asthmatic subjects over a three month period

Cited by 114 publications

References 24 publications

The Effect of Outdoor Fungal Spore Concentrations on Daily Asthma Severity

The Effect of Outdoor Fungal Spore Concentrations on Daily Asthma Severity

Retrospective Monitoring in the Management of Persistent Asthma

Questionnaires, spirometry and PEF monitoring in epidemiological studies on elderly respiratory patients

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