The need for standardisation of peak flow charts

Reddel, Helen K.; Vincent, Stephen; Civitico, J.

doi:10.1136/thx.2004.030437

Cited by 21 publications

(19 citation statements)

References 21 publications

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“…[1][2][3][4] However, there is still considerable disagreement on several aspects of asthma monitoring, from overall usefulness to standardization of graphic data rendering. 7,11,[15][16][17] Asthma home monitoring has been applied in 4 settings: self-management, in association with an asthma action plan [5][6][7] ; management of asthma patients by clinicians, including diagnosis refining, and retrospective therapy assessment [8][9][10][11] ; clinical trials and clinical research, where it is one of the most widely used investigation tools and a valuable source of information [18][19][20][21][22] ; and occupational asthma. [23][24] Our study dealt with retrospective monitoring of patients with poorly controlled persistent asthma and no previous experience of home monitoring, in a clinical management setting.…”

Section: Discussionmentioning

confidence: 99%

“…Since PEF ranges widely according to sex, height, age, and clinical conditions, 12 the left Y-axis range (200 -700 L/min) is adjusted in relation to the individual patient data being processed, to improve graph readability and facilitate rapid visual pattern recognition. 11 The mean actual left Y-axis lower and upper limits were 208.9 Ϯ 38.5 L/min and 640 Ϯ 83.7 L/min, respectively (as calculated from the data from 63 of the 84 patients). The graph also shows the predicted PEF value (according to Nunn and Gregg 13 ) and the patient's personal best PEF, with both horizontal lines (the personal-best line is dashed, and the predicted PEF is solid) and text.…”

Section: Data Graphingmentioning

confidence: 99%

“…In their thorough review of the subject, Reddel et al rightly pointed out that the important "bottleneck" in the graphing is how to combine clarity and plasticity, usually achieved via computerized treatment of the data, with ease and rapidity in generating the graphs, which they instead associate with manual entry. 11 We used a robust yet flexible scientific graphics platform (SigmaPlot) that allowed rapid data entry (Յ 5 min for 30 days of monitoring data) in a computerized form at follow-up visits, and high quality, immediate graphing of morning and evening PEF and symptoms on one graph that effectively shows the patient's status over one month (see Fig. 5).…”

Section: Graphing and Visual Pattern Recognitionmentioning

confidence: 99%

“…[5][6][7] On the other hand, retrospective monitoring allows fine diagnosis assessment and punctual therapy evaluation. [8][9][10][11] However, its application to routine clinical practice poses several still controversial questions: particularly, to whom and exactly when should retrospective monitoring be applied? For how long?…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, there is little consensus on the standardization of graphs obtained through recording of symptom score and PEF. 11 We applied a retrospective asthma-monitoring method, based on daily patient recording of symptom score and PEF on a diary card, in all new patients with poorly controlled persistent asthma, according to the Global Initiative for Asthma (GINA) 4 definition. These patients were consecutively seen during a 13-month period at our two asthma clinics, at the University of Bari, Bari, Italy, and the University of Foggia, Foggia, Italy.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Data Graphingmentioning

confidence: 99%

Section: Graphing and Visual Pattern Recognitionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Retrospective Monitoring in the Management of Persistent Asthma

et al. 2011

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Test di funzionalità respiratoria: l’esame spirometrico

Terzano

Malattie Dell’apparato Respiratorio

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Asthma outcomes: Pulmonary physiology

Tepper

Wise

Covar

et al. 2012

Journal of Allergy and Clinical Immunology

145

117

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Background Outcomes of pulmonary physiology have a central place in asthma clinical research. Objective At the request of National Institutes of Health (NIH) institutes and other federal agencies, an expert group was convened to provide recommendations on the use of pulmonary function measures as asthma outcomes that should be assessed in a standardized fashion in future asthma clinical trials and studies to allow for cross-study comparisons. Methods Our subcommittee conducted a comprehensive search of PubMed to identify studies that focused on the validation of various airway response tests used in asthma clinical research. The subcommittee classified the instruments as core (to be required in future studies), supplemental (to be used according to study aims and in a standardized fashion), or emerging (requiring validation and standardization). This work was discussed at an NIH-organized workshop in March 2010 and finalized in September 2011. Results A list of pulmonary physiology outcomes that applies to both adults and children older than 6 years was created. These outcomes were then categorized into core, supplemental, and emerging. Spirometric outcomes (forced expiratory volume in 1 second [FEV1], forced vital capacity [FVC], and FEV1/FVC) are proposed as core outcomes for study population characterization, for observational studies, and for prospective clinical trials. Bronchodilator reversibility and pre- and post-bronchodilator FEV1 also are core outcomes for study population characterization and observational studies. Conclusions The subcommittee considers pulmonary physiology outcomes of central importance in asthma and proposes spirometric outcomes as core outcomes for all future NIH-initiated asthma clinical research.

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The need for standardisation of peak flow charts

Cited by 21 publications

References 21 publications

Retrospective Monitoring in the Management of Persistent Asthma

Retrospective Monitoring in the Management of Persistent Asthma

Test di funzionalità respiratoria: l’esame spirometrico

Asthma outcomes: Pulmonary physiology

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