A randomized clinical trial of peak flow versus symptom monitoring in older adults with asthma.
OBJECTIVE
To determine whether peak flow monitoring has value above and beyond symptom monitoring when used as part of an asthma management plan.


METHODS
From a large managed-care organization, 296 adults, aged 50-92 yr, were recruited and randomly assigned in equal numbers to either use of symptoms or peak flow rate (twice daily or "as needed") for asthma monitoring, and monitored every 6 mo for 2 yr. Interventions were delivered in four 90-min small-group classes and included a personalized action plan and coaching in proper use of asthma inhalers.


RESULTS
We found no significant differences between peak flow rate and symptom monitoring, or between twice-daily and as-needed peak flow monitoring in the primary or secondary study outcomes: health care utilization (acute, nonacute, or total asthma visits), Asthma Quality-of-Life Questionnaire (AQLQ) scores, and lung function. AQLQ scores and prebronchodilator FEV1 increased significantly for both groups between baseline and 6 mo (AQLQ: mean, 0.4 units; 95% confidence interval, 0.3, 0.5; p < 0.0001; FEV1% predicted: mean, 4%). Inhaler technique improved substantially in both groups.


CONCLUSIONS
Peak flow monitoring has no advantage over symptom monitoring as an asthma management strategy for older adults with moderate-severe asthma when used in a comprehensive asthma management program. Improved outcomes in both groups suggest that understanding proper medication use, regular monitoring of asthma status, and understanding how to respond to changes are of primary importance.
Buist
A Sonia
AS
Oregon Health & Science University, Mail Code UHN 67, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA. buists@ohsu.edu
Vollmer
William M
WM
Wilson
Sandra R
SR
Frazier
E Ann
EA
Hayward
Arthur D
AD
D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D036501:Metered Dose Inhalers; D008991:Monitoring, Physiologic; D010366:Peak Expiratory Flow Rate; D011788:Quality of Life; D012907:Smoking / Q000453:epidemiology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome