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A Randomized Clinical Trial of Peak Flow versus Symptom Monitoring in Older Adults with Asthma

Oregon Health and Science University, Portland; Center for Health Research, and Northwest Permanente, Kaiser Permanente Northwest, Portland, Oregon; and Palo Alto Medical Foundation Research Institute, Palo Alto, California

Correspondence and requests for reprints should be addressed to A. Sonia Buist, M.D., Oregon Health & Science University, Mail Code UHN 67, 3181 SW Sam Jackson Park Road, Portland, OR 97239. E-mail: buists{at}ohsu.edu

Objective: To determine whether peak flow monitoring has value above and beyond symptom monitoring when used as part of an asthma management plan.

Methods: From a large managed-care organization, 296 adults, aged 50–92 yr, were recruited and randomly assigned in equal numbers to either use of symptoms or peak flow rate (twice daily or "as needed") for asthma monitoring, and monitored every 6 mo for 2 yr. Interventions were delivered in four 90-min small-group classes and included a personalized action plan and coaching in proper use of asthma inhalers.

Results: We found no significant differences between peak flow rate and symptom monitoring, or between twice-daily and as-needed peak flow monitoring in the primary or secondary study outcomes: health care utilization (acute, nonacute, or total asthma visits), Asthma Quality-of-Life Questionnaire (AQLQ) scores, and lung function. AQLQ scores and prebronchodilator FEV₁ increased significantly for both groups between baseline and 6 mo (AQLQ: mean, 0.4 units; 95% confidence interval, 0.3, 0.5; p < 0.0001; FEV₁% predicted: mean, 4%). Inhaler technique improved substantially in both groups.

Conclusions: Peak flow monitoring has no advantage over symptom monitoring as an asthma management strategy for older adults with moderate–severe asthma when used in a comprehensive asthma management program. Improved outcomes in both groups suggest that understanding proper medication use, regular monitoring of asthma status, and understanding how to respond to changes are of primary importance.

Key Words: health care utilization • lung function • quality of life • self-management

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Although peak flow monitoring is recommended in treatment guidelines, there have been no studies to determine whether peak flow monitoring has value above and beyond symptom monitoring when used as part of an asthma management plan for older adults. What This Study Adds to the Field Peak flow monitoring had no advantage over symptom monitoring as an asthma management strategy for older adults with moderate-to-severe asthma.

 

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Peak Expiratory Flow Monitoring in Older Patients with Asthma: An Aid to Management?

Dirkje S. Postma and Marike H. M. Boezen
AJRCCM 2006 174: 1065-1066. [Full Text]  

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