Skip to main content
PMC home page
Thorax logoLink to Thorax
. 1995 Aug;50(8):851–857. doi: 10.1136/thx.50.8.851

Peak flow based asthma self-management: a randomised controlled study in general practice. British Thoracic Society Research Committee.

K P Jones 1, M A Mullee 1, M Middleton 1, E Chapman 1, S T Holgate 1
PMCID: PMC474903  PMID: 7570436

Abstract

BACKGROUND--Peak flow based asthma self-management plans have been strongly advocated in consensus statements, but convincing evidence for the effectiveness of this approach has been largely lacking. METHODS--A randomised controlled trial was conducted in 25 general practices comparing an asthma self-management programme based on home peak flow monitoring and surgery review by a general practitioner or practice nurse with a programme of planned visits for surgery review only over a six month period. RESULTS--Seventy two subjects (33 in the self-management group and 39 in the planned visit group) completed the study protocol, but diary card data for at least three months were available on a total of 84 (39 in the self-management group and 45 in the planned visit group). Teaching self-management took longer than the planned visit review. In the self-management group home peak flow monitoring was felt to be useful by doctors and patients in 28 (85%) and 27 (82%) cases, respectively. There were no between group differences during the study period in terms of lung function, symptoms, quality of life, and prescribing costs. Only within the self-management group were improvements noted in disturbance of daily activities and quality of life. Possible explanations for these negative results include small numbers of subjects, the mild nature of their asthma, and inappropriate self-management strategies for such patients. CONCLUSIONS-- Rigid adherence to long term daily peak flow measurement in the management of mild asthma in general practice does not appear to produce large changes in outcomes. Self-management and the use of prescribed peak flow meters need to be tailored to individual circumstances.

Full text

PDF
856

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Beasley R., Cushley M., Holgate S. T. A self management plan in the treatment of adult asthma. Thorax. 1989 Mar;44(3):200–204. doi: 10.1136/thx.44.3.200. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Brewis R. A. Patient education, self-management plans and peak flow measurement. Respir Med. 1991 Nov;85(6):457–462. doi: 10.1016/s0954-6111(06)80262-3. [DOI] [PubMed] [Google Scholar]
  3. Charlton I., Bain J. The care of children with asthma in general practice: signs of progress. Br J Gen Pract. 1991 Jun;41(347):256–256. [PMC free article] [PubMed] [Google Scholar]
  4. Charlton I., Charlton G., Broomfield J., Mullee M. A. Evaluation of peak flow and symptoms only self management plans for control of asthma in general practice. BMJ. 1990 Dec 15;301(6765):1355–1359. doi: 10.1136/bmj.301.6765.1355. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Clark N. M., Evans D., Mellins R. B. Patient use of peak flow monitoring. Am Rev Respir Dis. 1992 Mar;145(3):722–725. doi: 10.1164/ajrccm/145.3.722. [DOI] [PubMed] [Google Scholar]
  6. D'Souza W., Crane J., Burgess C., Te Karu H., Fox C., Harper M., Robson B., Howden-Chapman P., Crossland L., Woodman K. Community-based asthma care: trial of a "credit card" asthma self-management plan. Eur Respir J. 1994 Jul;7(7):1260–1265. doi: 10.1183/09031936.94.07071260. [DOI] [PubMed] [Google Scholar]
  7. Dekker F. W., Kaptein A. A., van der Waart M. A., Gill K. Quality of self-care of patients with asthma. J Asthma. 1992;29(3):203–208. doi: 10.3109/02770909209099028. [DOI] [PubMed] [Google Scholar]
  8. Gregg I. Can measurement of peak expiratory flow enhance compliance in chronic asthma? Eur Respir J. 1992 Jan;5(1):136–138. [PubMed] [Google Scholar]
  9. Gunawardena K. A., Houston K., Smith A. P. Evaluation of the turbine pocket spirometer. Thorax. 1987 Sep;42(9):689–693. doi: 10.1136/thx.42.9.689. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Hyland M. E., Finnis S., Irvine S. H. A scale for assessing quality of life in adult asthma sufferers. J Psychosom Res. 1991;35(1):99–110. doi: 10.1016/0022-3999(91)90011-c. [DOI] [PubMed] [Google Scholar]
  11. Hyland M. E., Kenyon C. A., Allen R., Howarth P. Diary keeping in asthma: comparison of written and electronic methods. BMJ. 1993 Feb 20;306(6876):487–489. doi: 10.1136/bmj.306.6876.487. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Janson-Bjerklie S., Shnell S. Effect of peak flow information on patterns of self-care in adult asthma. Heart Lung. 1988 Sep;17(5):543–549. [PubMed] [Google Scholar]
  13. Jones K. P., Bain D. J., Middleton M., Mullee M. A. Correlates of asthma morbidity in primary care. BMJ. 1992 Feb 8;304(6823):361–364. doi: 10.1136/bmj.304.6823.361. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Jones K. P., Charlton I. H., Middleton M., Preece W. J., Hill A. P. Targeting asthma care in general practice using a morbidity index. BMJ. 1992 May 23;304(6838):1353–1356. doi: 10.1136/bmj.304.6838.1353. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Klingelhofer E. L. Compliance with medical regimens, self-management programs, and self-care in childhood asthma. Clin Rev Allergy. 1987 Aug;5(3):231–247. doi: 10.1007/BF02991197. [DOI] [PubMed] [Google Scholar]
  16. Klingelhofer E. L., Gershwin M. E. Asthma self-management programs: premises, not promises. J Asthma. 1988;25(2):89–101. doi: 10.3109/02770908809071359. [DOI] [PubMed] [Google Scholar]
  17. Miller M. R., Dickinson S. A., Hitchings D. J. The accuracy of portable peak flow meters. Thorax. 1992 Nov;47(11):904–909. doi: 10.1136/thx.47.11.904. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Neville R. G., Clark R. C., Hoskins G., Smith B. National asthma attack audit 1991-2. General Practitioners in Asthma Group. BMJ. 1993 Feb 27;306(6877):559–562. doi: 10.1136/bmj.306.6877.559. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Partridge M. R. Asthma: guided self management. BMJ. 1994 Feb 26;308(6928):547–548. doi: 10.1136/bmj.308.6928.547. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Rachelefsky G. S. Review of asthma self-management programs. J Allergy Clin Immunol. 1987 Sep;80(3 Pt 2):506–511. doi: 10.1016/0091-6749(87)90087-x. [DOI] [PubMed] [Google Scholar]
  21. Sly P. D., Cahill P., Willet K., Burton P. Accuracy of mini peak flow meters in indicating changes in lung function in children with asthma. BMJ. 1994 Feb 26;308(6928):572–574. doi: 10.1136/bmj.308.6928.572. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES