title: Actual over best function as an outcome measure in asthma.
abstract: Several guidelines for the management of asthma suggest that actual/best function is a useful outcome measure. This implies accurate assessment of best function, and a standard for the proportion of best function to be achieved. Seventeen clinics observed their practice simultaneously during four periods in 1990. The aims of the study included testing a protocol for the assessment of best function, and validating actual/best function as an outcome measure. The proposed target for actual/best function to indicate satisfactory control was 80%. The protocol for assessment of best function required formal trial of steroids if best function was < 70% predicted; with regular recording of peak expiratory flow (PEF) if < 80% predicted. PEF was recorded in 515 and FEV1 in 680 of 767 subjects, following the usual clinic practice. If the protocol for best function was not satisfied, mean actual/best function was no higher than if it was, except when best PEF was < 70% predicted. This suggests the need for a PEF chart in these latter patients. Best function was greater in females than males, but actual/best function was almost identical. Whilst best function declined with increasing intensity of treatment, actual/best function was almost independent of regimen step, particularly in the centre which most closely adhered to the protocol. These results confirm that actual/best function is a valid outcome measure. Mean actual/best was > 80% except for FEV1 in two centres. It is suggested that the target in chronic management of asthma is raised from 80 to 85% of best, when actual/best PEF is used as a spot check in patients believed to be on optimal therapy.
authors.affiliation: Department of Medicine, Memorial Hospital, Darlington, U.K.
authors.forename: C K
authors.initials: CK
authors.lastname: Connolly
authors.forename: R J
authors.initials: RJ
authors.lastname: Prescott
authors.forename: S M
authors.initials: SM
authors.lastname: Alcock
authors.forename: A A
authors.initials: AA
authors.lastname: Gatnash
mesh_terms: D001249:Asthma / Q000503:physiopathology*; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010366:Peak Expiratory Flow Rate / Q000502:physiology; D012129:Respiratory Function Tests; D012737:Sex Factors; D016896:Treatment Outcome