Published ahead of print on August 24, 2006, doi:10.1164/rccm.200510-1606OC Am. J. Respir. Crit. Care Med., Volume 174, Number 10, November 2006, 1077-1087 A more recent version of this article appeared on November 15, 2006
Submitted on October 13, 2005 A Randomized Clinical Trial of Peak Flow versus Symptom Monitoring in Older Adults with AsthmaA. Sonia Buist1*,1 Oregon Health and Science University, Portland, Oregon, USA, 2 Kaiser-Permanente Northwest, Center for Health Research, Portland, Oregon, USA, 3 Palo Alto Medical Foundation Research Institute, Palo Alto, California, USA, 4 Kaiser Permanente Northwest, Northwest Permanente, Portland, Oregon, USA * To whom correspondence should be addressed. 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, ages 50-92 years, 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 followed every six months for two years. Interventions were delivered in four 90-minute 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, non-acute, or total asthma visits), Asthma Quality of Life Questionnaire (AQLQ) scores, and lung function. AQLQ scores and pre-bronchodilator FEV1 increased significantly for both groups between baseline and 6-months (AQLQ Mean. 0.4 units, 95% CI = 0.3, 0.5, p < .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: self-management, health care utilization, lung function, quality of life
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