Evaluation of peak flow and symptoms only self management plans for control of asthma in general practice.
OBJECTIVE
To compare a peak flow self management plan for asthma with a symptoms only plan.


METHODS
Randomisation to one of the self management plans and follow up for a year.


METHODS
Four partner, rural training practice in Norfolk.


METHODS
115 Patients (46 children and 69 adults) with asthma who were having prophylactic treatment for asthma and attending a nurse run asthma clinic.


METHODS
The number of doctor consultations, courses of oral steroids, and short term nebulised salbutamol treatments and the number of patients who required doctor consultations, courses of oral steroids, and short term nebulised salbutamol.


RESULTS
Both self management plans produced significant reductions in the outcome measures but there were no significant differences in the degree of improvement between the groups. The results were similar for children and adults. The proportions of patients requiring a doctor consultation fell from 98% (50/51) to 66% (34/51) in the peak flow group and from 97% (62/64) to 53% (34/64) in the symptoms only group and the proportions requiring oral steroids from 73% (34/46) to 47% (21/46) and 52% (31/60) to 12% (7/60). The median number of doctor consultations was reduced from 8.0 to 2.0 in the peak flow group and from 4.5 to 1.0 in the symptoms only group.


CONCLUSIONS
The peak flow meter was not the crucial ingredient in the improved illness of the two groups. Teaching patients the importance of their symptoms and the appropriate action to take when their asthma deteriorates is the key to effective management of asthma. Simply prescribing peak flow meters without a system of self management and regular review will be unlikely to improve patient care.
Charlton
I
I
University of Southampton.
Charlton
G
G
Broomfield
J
J
Mullee
M A
MA
D000284:Administration, Oral; D000328:Adult; D000336:Aerosols; D000420:Albuterol / Q000008:administration & dosage; D001249:Asthma / Q000503:physiopathology / Q000517:prevention & control*; D002648:Child; D005194:Family Practice; D006801:Humans; D009819:Office Visits / Q000706:statistics & numerical data; D010353:Patient Education as Topic; D010366:Peak Expiratory Flow Rate; D011379:Prognosis; D012212:Rheology; D012648:Self Care; D013256:Steroids / Q000008:administration & dosage
D000336:Aerosols; D013256:Steroids; D000420:Albuterol