Peak flow monitoring in clinical practice and clinical asthma trials

Current Opinion in Pulmonary Medicine

Volumn 12, Issue 1, 2006, Pages 75-81

  Reddel, Helen K ^a  

^a WOOLCOCK INSTITUTE OF MEDICAL RESEARCH   (Australia)

Author keywords

Ambulatory monitoring; Asthma; Peak expiratory flow

Indexed keywords

ALGORITHM; AMBULATORY MONITORING; ASTHMA; CIRCADIAN RHYTHM; CLINICAL PRACTICE; CLINICAL TRIAL; DATA ANALYSIS; DATA SYNTHESIS; DIAGNOSTIC ACCURACY; DIAGNOSTIC VALUE; DISEASE EXACERBATION; HUMAN; INTERNET; MEDICAL RECORD; PATIENT MONITORING; PEAK EXPIRATORY FLOW; QUALITY CONTROL; REVIEW; STATISTICAL MODEL; TREATMENT RESPONSE; CLINICAL COMPETENCE; METHODOLOGY; MONITORING; STANDARD;

ASTHMA; CLINICAL COMPETENCE; CLINICAL TRIALS; HUMANS; MEDICAL RECORDS; MONITORING, PHYSIOLOGIC; PEAK EXPIRATORY FLOW RATE;

EID: 33646850898     PISSN: 10705287     EISSN: 15316971     Source Type: Journal    
DOI: 10.1097/01.mcp.0000198065.65704.08     Document Type: Review

References (30)

1. US National Institutes of Health. Global Initiative for Asthma: Global strategy for asthma management and prevention, updated 2005. Bethesda, MA: National Institutes of Health; 2005. http://www.ginasthma.com/GuidelineItem. asp?intId=60 [Accessed 25 October 2005].
2. US National Institutes of Health. National Asthma Education and Prevention Program Expert Panel Report 2. Guidelines for the diagnosis and management of asthma. NIH Publication 97-4051. Bethesda, MA: National Institutes of Health; 1997.
3. Oga T, Nishimura K, Tsukino M, et al. Longitudinal changes in patient vs. physician-based outcome measures did not significantly correlate in asthma. J Clin Epidemiol 2005; 58:532-539.
4. Koh YY, Kang H, Yoo Y, et al. Peak expiratory flow variability and exercise responsiveness in methacholine-hyperresponsive adolescents with asthma remission. J Asthma 2005; 42:17-23.
5. Boushey HA, Sorkness CA, King TS, et al. Daily versus as-needed corticosteroids for mild persistent asthma. N Engl J Med 2005; 352:1519-1528.
6. O'Byrne PM, Bisgaard H, Godard PP, et al. Budesonide/formoterol combination therapy as both maintenance and reliever medication in asthma. Am J Resp Crit Care Med 2005; 171:129-136.
7. Lambert PC, Burton PR, Abrams KR, et al. The analysis of peak expiratory flow data using a three-level hierarchical model. Stat Med 2004; 23:3821-3839. This paper describes a proposed model for analysing PEF data in order to improve the information that can be obtained about within-day and between-day PEF variability as well as about absolute levels.
8. Frey U, Brodbeck T, Majumdar A, et al. Risk of severe asthma episodes predicted from fluctuation analysis of airway function. Nature 2005 (in press).
9. Taylor DRT, Town GI, Herbison GP, et al. Asthma control during long-term treatment with regular inhaled salbutamol and salmeterol. Thorax 1998; 53:744-752.
10. Bateman ED, Boushey HA, Bousquet J, et al. Can guideline-defined asthma control be achieved? The Gaining Optimal Asthma ControL study. Am J Resp Crit Care Med 2004; 170:836-844.
11. British Thoracic Society, Scottish Intercollegiate Guidelines Network. British guideline on the management of asthma: a national clinical guideline, revised edition April 2004. London, UK: British Thoracic Society; 2004. http://www.brit-thoracic.org.uk/c2/uploads/asthmafull.pdf [Accessed 25 October 2005].
12. Gibson PG, Powell H, Coughlan J, et al. Self-management education and regular practitioner review for adults with asthma (Cochrane review). In: The Cochrane library, issue 1. Oxford, UK: Update Software; 2003.
13. Gibson PG, Powell H. Written action plans for asthma: an evidence-based review of the key components. Thorax 2004; 59:94-99. This paper is a useful resource for clinicians designing asthma action plans. It provides ameta-analysis of 26 published studies of written action plans, identifying their key components and the impact on outcomes such as hospitalization.
14. Reddel HK, Marks GB, Jenkins CR. When can personal best peak flow be determined for asthma action plans? Thorax 2004; 59:922-924. This report provides advice about when an asthma action plan can be written, based on the time course of improvement in personal best PEF and symptoms after commencement of asthma treatment.
15. Gibson PG, Wlodarczyk J, Hensley MJ, et al. Using quality-control analysis of peak expiratory flow recordings to guide therapy for asthma. Ann Intern Med 1995; 123:488-492.
16. Reddel HK, Vincent SD, Civitico J. The need for standardisation of peak flow charts. Thorax 2005; 60:164-167. This paper identifies a dramatic range of scale in currently available PEF charts, and illustrates the impact on the appearance of severe asthma exacerbations. The authors draw on visual perception literature to explain this phenomenon and call for standardization of PEF charts to facilitate development of clinical pattern recognition skills.
17. de Asis ML, Greene R. A cost-effectiveness analysis of a peak flow-based asthma education and self-management plan in a high-cost population. J Asthma 2004; 41:559-565.
18. Cowie RL, Revitt SG, Underwood MF, et al. The effect of a peak flow-based action plan in the prevention of exacerbations of asthma. Chest 1997; 112:1534-1538.
19. Wensley D, Silverman M. Peak flow monitoring for guided self-management in childhood asthma: a randomized controlled trial. Am J Resp Crit Care Med 2004; 170:606-612. This paper reports a study of PEF-based and symptom-based action plans in children, which demonstrates that a 70% PEF action point is too stringent a criterion for most patients.
20. Chan-Yeung M, Chang JH, Manfreda J, et al. Changes in peak flow, symptom score, and the use of medications during acute exacerbations of asthma. Am J Resp Crit Care Med 1996; 154:889-893.
21. Pauwels RA, Lofdahl C-G, Postma DS, et al. Effect of inhaled formoterol and budesonide on exacerbations of asthma. N Engl J Med 1997; 337:1405-1411.
22. Ostojic V, Cvoriscec B, Ostojic SB, et al. Improving asthma control through telemedicine: a study of short-message service. Telemed JE Health 2005; 11:28-35.
23. Rasmussen LM, Phanareth K, Nolte H, et al. Internet-based monitoring of asthma: a long-term, randomized clinical study of 300 asthmatic subjects. J Allergy Clin Immunol 2005; 115:1137-1142. This paper describes a large study of Internet-based monitoring with specialist feedback, compared with outpatient specialist care and general practitioner care. It demonstrates the feasibility and benefit of adding regular physician feedback to routine monitoring, using an Internet interface.
24. Anhoj J, Nielsen L. Quantitative and qualitative usage data of an Internet-based asthma monitoring tool. J Med Internet Res 2004; 6:e23. This paper provides patient and general practitioner perspectives on the advantages and limitations of web-based asthma management systems.
25. Palmblad M, Tiplady B. Electronic diaries and questionnaires: designing user interfaces that are easy for all patients to use. Qual Life Res 2004; 13:1199-1207. This paper deals primarily with questionnaires rather than PEF, but provides important advice for clinicians who are designing asthma diaries for electronic interfaces.
26. FitzGerald JM, Becker A, Sears MR, et al. Doubling the dose of budesonide versus maintenance treatment in asthma exacerbations. Thorax 2004; 59:550-556. This paper reports an interesting study that demonstrated that the traditional doubling of inhaled corticosteroids is ineffective in the management of asthma exacerbations. It provides a good example of the strengths and limitations of electronic monitoring devices.
27. D'Alonzo GE, Volker WS, Keller A. Measurements of morning and evening airflow grossly underestimate the circadian variability of FEV1 and peak expiratory flow rate in asthma. Am J Resp Crit Care Med 1995; 152:1097-1099.
28. Gannon PFG, Newton DT, Pantin CFA, et al. Effect of the number of peak expiratory flow readings per day on the estimation of diurnal variation. Thorax 1998; 53:790-792.
29. Anees W, Gannon PF, Huggins V, et al. Effect of peak expiratory flow data quantity on diagnostic sensitivity and specificity in occupational asthma. Eur Respir J 2004; 23:730-734. This is an important paper for anyone who is involved in diagnosis of occupational asthma. It provides recommendations for the minimum quantity of PEF data that should be obtained to optimize diagnostic accuracy for occupational asthma.
30. Alemi F, Neuhauser D. Time-between control charts for monitoring asthma attacks. Jt Comm J Qual Saf 2004; 30:95-102.