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Published ahead of print on June 7, 2004, doi:10.1164/rccm.200307-1025OC

Am. J. Respir. Crit. Care Med., Volume 170, Number 6, September 2004, 606-612

A more recent version of this article appeared on September 15, 2004
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Submitted on July 25, 2003
Accepted on June 3, 2004

Peak Flow Monitoring for Guided Self-management in Childhood Asthma: A Randomised Controlled Trial

Diane Wensley1 and Mike Silverman1*

1 Department of Child Health and Institute for Lung Health, University of Leicester, Leicester, United Kingdom

* To whom correspondence should be addressed. E-mail: ms70{at}le.ac.uk.

We asked whether the addition of peak expiratory flow (PEF) recordings to a symptom-based self-management plan improved outcome in school children with asthma. In an open randomised, parallel group, controlled trial we studied children aged 7-14 with moderate asthma. After a 4-week run-in, 90 children were randomised to receive either PEF plus symptom-based management or symptom-based management alone, for 12 weeks. Thresholds for action based on PEF were 70% of best (for increasing inhaled steroids) and 50% of best (for commencing prednisolone). Children were asked to perform twice daily spirometry at home (using an electronic recording spirometer which revealed only PEF to the study group alone) and record a symptom diary. Mean daily symptom score was the main outcome. There were no differences between groups in mean symptom score or in spirometric lung function, PEF, quality of life score or reported use of health services over 12 weeks. During acute episodes children responded to changes in symptoms by increasing their inhaled steroids at a mean value of PEF of greater than 70% of best, so that overall PEF did not contribute to this important self-management decision. Knowledge of PEF did not enhance self- management even during acute exacerbations.
Key words: Spirometry, quality of life, health service utilization




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