BMJ 1994;308:564-567 (26 February)

Papers

Effectiveness of routine self monitoring of peak flow in patients with asthma

N Drummond, M Abdalla, J A G Beattie, J K Buckingham, T Lindsay, L M Osman, S J Ross, A Roy-Chaudhury, I Russell, M Turner, J A R Friend, J S Legge, J G Douglas,  for the Grampian Asthma Study of Integrated Care (GRASSIC)

Health Services Research Unit, University of Aberdeen, Aberdeen AB9 2ZD Thoracic Medicine Unit, Aberdeen Royal Hospital, Trust, City Hospital, Aberdeen AB9 8AU Correspondence and requests for reprints to: Mr Drummond.

Abstract

Objective : To evaluate the effectiveness of routine self monitoring of peak flow for asthma outpatients.
Design : Pragmatic randomised trial.
Setting : Hospital outpatient clinics and general practices in north east Scotland.
Main outcome measures : Use of bronchodilators and inhaled and oral steroids; number of general practice consultations and hospital admissions for asthma; sleep disturbance and other restrictions on normal activity; psychological aspects of health including perceived control of asthma.
Results : After one year there were no significant differences between patients randomised between self monitoring of peak flow and conventional monitoring. However, those given a peak flow meter recorded an increase in general practice consultations that was nearly significant. Among patients whose asthma was judged on entry to be more severe, those allocated to self monitoring used more than twice as many oral steroids (2.2; 95% confidence interval 1.1 to 4.6). Patients who already possessed a peak flow meter at the start of the study recorded higher morbidity over the course of the year than those eligible for randomisation.
Conclusion : Prescribing peak flow meters and giving self management guidelines to all asthma patients is unlikely to improve mortality or morbidity.Patients whose asthma is severe may benefit from such an intervention.

Clinical implications

  • Clinical implications

  • Peak flow meters have become ubiquitous in the diagnosis and management of asthma in general practice

  • The effectiveness of peak flow meters as self monitoring devices remains in doubt

  • Patients randomised to receive a peak flow meter and self management guidelines experienced little clinical benefit over the course of one year

  • Peak flow meters as self monitoring devices should be targeted at patients whose asthma is more severe or difficult to treat


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