title: Symptom monitoring in childhood asthma: a randomized clinical trial comparing peak expiratory flow rate with symptom monitoring.
abstract: BACKGROUND
  Accurate symptom evaluation is a critical component of asthma management. Limited data are available about the accuracy of symptom evaluation by children with asthma and their parents, or the impact of various symptom-monitoring strategies on asthma morbidity outcomes.
  
  
  OBJECTIVE
  The purpose of this randomized clinical trial was to evaluate the effect of three different intensities of symptom monitoring on asthma morbidity outcomes.
  
  
  METHODS
  One hundred sixty-eight children (ages 6 to 19) of diverse racial, geographic, and socioeconomic backgrounds were randomized to 1 of 3 treatment groups (subjective symptom evaluation, symptom-time peak expiratory flow rate (PEFR) monitoring, daily PEFR monitoring) in this longitudinal, clinical trial. Outcome measures included a summary asthma severity score, forced expiratory volume in 1 second, symptom days, and health care utilization.
  
  
  RESULTS
  Children who used PEFR meters (PFMs) when symptomatic had a lower asthma severity score, fewer symptom days, and less health care utilization than children in the other two treatment groups. Minority and poor children had the greatest amount of improvement using PFMs when symptomatic. Results were much less striking in white families. Thirty percent of families in the PFM treatment groups discontinued use entirely by 1 year postexit, whereas the majority of families who continued use (94%) used them only when symptomatic to inform symptom interpretation and management decisions.
  
  
  CONCLUSIONS
  Not every child with asthma needs a PFM. Children and families facing extra challenges as a result of illness severity, sociodemographic, or health care system characteristics clearly benefited most from PFM use.
authors.affiliation: University of Rochester School of Nursing and Department of Pediatrics, New York, USA. lorrie_yoos@urmc.rochester.edu
authors.forename: H Lorrie
authors.initials: HL
authors.lastname: Yoos
authors.forename: Harriet
authors.initials: H
authors.lastname: Kitzman
authors.forename: Ann
authors.initials: A
authors.lastname: McMullen
authors.forename: Charles
authors.initials: C
authors.lastname: Henderson
authors.forename: Kimberly
authors.initials: K
authors.lastname: Sidora
mesh_terms: D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000175:diagnosis / Q000208:ethnology / Q000503:physiopathology*; D002648:Child; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008448:Maximal Expiratory Flow Rate; D008991:Monitoring, Physiologic / Q000295:instrumentation*; D009017:Morbidity; D010349:Patient Compliance