Asthma self-management education program by home monitoring of peak expiratory flow.

Abstract

A prospective controlled trial of home monitoring of peak expiratory flow rate (PEFR) was conducted to determine the usefulness of an objective measure of lung function in association with an education program and a medication self-management plan in reducing morbidity in adult patients with asthma. Thirty-five patients managed themselves, using peak flow readings as the basis for the therapeutic plan coupled with educational intervention, whereas 35 control patients used symptoms and spirometric data for following physicians' treatment plans. After a 6-mo study period, patients in the experimental group showed statistically significant improvements in morbidity parameters (days lost from work, acute asthma attacks, days on antibiotic therapy, physician consultations, and emergency room admissions for asthma), increases in FVC, FEV1, and FEV1/FVC, mean PEFR and mean morning PEFR, decrease in percentage of the mean PEFR amplitude, and a reduction in the use of inhaled beta-agonists, oral theophylline, and oral prednisone. Although improvements in some of these parameters were also found in the control group, they did not reach the levels of significance obtained in the experimental group. The personal use of an objective measure of lung function in association with a medication self-management plan leads to improvement in the patient's condition.

A multivariate model for predicting respiratory status in patients with chronic obstructive pulmonary disease

“…[1][2][3][4] When combined with individualized treatment plans, monitoring has been shown to improve symptoms, decrease resource consumption, and favorably affect the physiologic processes implicated in asthmatic attacks. [5][6][7][8][9] We conducted a prospective, double-blind study to determine if PEFR monitoring could be of similar value in patients with advanced COPD.…”

“…[1][2][3][4] Treatment programs based on these measurements have been shown to reduce symptoms, 5 the number of attacks, 6 days lost from work, 5,6 medication requirements, [5][6][7] airflow variability, 8,9 the response to histamine challenge, 8 and physician consultations and emergency department admissions. 6 Despite these successes, the role of peak flow monitoring in management of chronic obstructive pulmonary disease (COPD) is unknown. Few studies have examined the significance of a falling PEFR or whether monitoring provides information that cannot be obtained by other means.…”

The use of the self-management plan system of care in adult asthma

“…This view is supported by the observation that patients enrolled in a number of the studies were previously taking inhaled corticosteroids and that with regular assessment as a result of the use of a management plan, their inhaled corticosteroid dose was appropriately increased, with a resulting improvement in asthma control [1,7,12].…”

“…Thus, self-management plans can be considered to provide practical guidelines in which the recommendations for acute se- vere and chronic persistent asthma can be brought together within the framework of one system. The basic structure of this standardised prototype plan has been used in most studies which have assessed the efficacy of this form of care [1,[6][7][8][9][10][11][12][13].…”

“…For example, in the situation of severe asthma requiring oral steroids and medical review, values ranging from 50 to 70% of personal best or predicted peak flow have been recommended [1,[6][7][8][9][10]12,13]. While the use of personal best, rather than predicted peak flow levels is now recognised as preferable for reference values, the absolute percentage levels to be used at each stage remain uncertain [14].…”