ASTHMA

When can personal best peak flow be determined for asthma action plans?

H K Reddel, G B Marks, C R Jenkins

Woolcock Institute of Medical Research, Camperdown, NSW, Australia

Correspondence to:
Correspondence to:
Dr H K Reddel
P O Box M77, Missenden Road, Camperdown, NSW 2050, Australia; hkr{at}woolcock.org.au

Background: Written asthma action plans based on personal best peak expiratory flow (PEF) consistently improve health outcomes, whereas those based on predicted PEF do not. Guidelines state that personal best PEF should be assessed over 2–3 weeks during good asthma control, but it is unclear how long to wait after commencing or changing treatment.

Methods: Electronically recorded spirometric data from 61 subjects with initially poorly controlled asthma from a 72 week budesonide study were analysed. For each week, average morning pre-bronchodilator PEF was calculated and personal best PEF was determined as the highest PEF in the previous 2 weeks. The time to plateau was defined as the week beyond which no further improvement occurred.

Results: At baseline, average morning PEF was 61% predicted and personal best PEF was 87% predicted. Personal best PEF from twice daily monitoring increased to a plateau of 95% predicted (p<0.0001) after only 3 weeks of budesonide treatment. However, average morning PEF continued to improve for 3 months and "as needed" reliever use for 7 months.

Conclusions: Personal best PEF is a useful concept for asthma self-management plans when determined as the highest PEF over the previous 2 weeks. With twice daily monitoring, personal best PEF reaches plateau levels after only a few weeks of corticosteroid treatment.

Keywords: asthma; asthma action plan; peak expiratory flow; patient education; personal best

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Reddel, H. K., Taylor, D. R., Bateman, E. D., Boulet, L.-P., Boushey, H. A., Busse, W. W., Casale, T. B., Chanez, P., Enright, P. L., Gibson, P. G., de Jongste, J. C., Kerstjens, H. A. M., Lazarus, S. C., Levy, M. L., O'Byrne, P. M., Partridge, M. R., Pavord, I. D., Sears, M. R., Sterk, P. J., Stoloff, S. W., Sullivan, S. D., Szefler, S. J., Thomas, M. D., Wenzel, S. E., on behalf of the American Thoracic Society/Europea, (2009). An Official American Thoracic Society/European Respiratory Society Statement: Asthma Control and Exacerbations: Standardizing Endpoints for Clinical Asthma Trials and Clinical Practice. Am. J. Respir. Crit. Care Med. 180: 59-99 [Abstract] [Full Text]  
• Thorsteinsdottir, B., Volcheck, G. W., Madsen, B. E., Patel, A. M., Li, J. T. C., Lim, K. G. (2008). The ABCs of Asthma Control. Mayo Clin Proc. 83: 814-820 [Abstract] [Full Text]  
• Bateman, E. D., Hurd, S. S., Barnes, P. J., Bousquet, J., Drazen, J. M., FitzGerald, M., Gibson, P., Ohta, K., O'Byrne, P., Pedersen, S. E., Pizzichini, E., Sullivan, S. D., Wenzel, S. E., Zar, H. J. (2008). Global strategy for asthma management and prevention: GINA executive summary. Eur Respir J 31: 143-178 [Abstract] [Full Text]  
• (2005). Minerva. BMJ 330: E339-E339 [Full Text]  
• (2004). Minerva. BMJ 329: 1246-1246 [Full Text]  
• Ruffin, R (2004). Peak expiratory flow (PEF) monitoring. Thorax 59: 913-914 [Full Text]  

eLetters:

Read all eLetters

PEF or FEF 75% in asthma management?

Fabrizio Della Torre, et al.

Thorax Online, 4 Jan 2005 [Full text]