Chest
Volume 113, Issue 4, April 1998, Pages 968-972
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Clinical Investigations: Asthma
Compliance With Peak Expiratory Flow Monitoring in Home Management of Asthma

https://doi.org/10.1378/chest.113.4.968Get rights and content

Background

The recent consensus reports on asthma management emphasize the importance of using peak flowmeters to accurately assess the degree of airflow obstruction. However, the optimal way to use those devices has not yet been determined.

Objectives

To assess compliance with peak expiratory flow (PEF) measurements in the long-term management of asthma, and identify the characteristics of patients with poor compliance.

Setting

Asthma clinics from three tertiary-care hospitals.

Design

A descriptive and prospective study of 1-year duration.

Patients

Twenty-six patients with moderate to severe asthma taking part in an asthma education program.

Main outcome measures

Patients were asked to measure morning and evening PEF using an electronic peak flowmeter with a 3-month memory; they were unaware that PEF values were being recorded by this device.

Results

Compliance with PEF measurements was relatively good during the first month (63% of the measurements done) but even with regular reinforcement, fell to 50% at 6 months and to 33% at 12 months. Right from the beginning, 8 of 26 subjects (30%) never or almost never (<5% of the readings done) measured PEF, with seven of these subjects writing fabricated results in their diaries most of the time. At 12 months, 60% of the subjects were measuring PEF <25% of the time, and most of them continued writing fabricated PEF values in their diaries. None of the subjects' characteristics helped us to identify those who had poor compliance with these measurements.

Conclusions

While short-term compliance with PEF measurements is fairly good, most patients with moderate to severe asthma are not interested in measuring PEF twice daily over a prolonged period. In the current management of asthma, PEF measurement devices can be suggested to those showing a strong personal interest in using them, but should be limited to short periods of time. Furthermore, this study outlines the usefulness of electronic peak flowmeters when doing clinical research where PEF improvement is an important outcome.

Section snippets

METHODS

Twenty-six patients with moderate to severe asthma from three different asthma clinics were enrolled. They were a subgroup of subjects who participated in a randomized, controlled trial of 1 year's duration assessing the value of an educational program based either on PEF or asthma symptom monitoring. Twenty-three subjects had dropped out of the study for various reasons (nonattenders, or group NA). The remaining 26 subjects were randomly assigned to take part in an asthma education program

RESULTS

As Table 1 shows, the 26 subjects who were given the electronic peak flowmeter (educated patients, or group EP) were similar to the control patients who received the usual care treatment (group C) and to those subjects who did not complete the study (group NA) with regard to age, sex, asthma duration, atopy, and the daily dose of inhaled corticosteroids needed to maintain good asthma control.

Throughout the study period, the average compliance decreased from 63% of measurements at 1 month, to

DISCUSSION

This study shows that short-term compliance with PEF monitoring is fairly good, although one third of the subjects did not comply right from the start despite having been given specific information on the usefulness of the portable device in the management of their asthma. However, long-term compliance with such monitoring is poor, even among a group of patients who have moderate to severe asthma requiring daily use of inhaled corticosteroids and who are motivated to take part in an asthma

REFERENCES (20)

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Supported by a grant from Glaxo Wellcome Canada, Mississauga, Ontario, Canada.

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