Caring for patients with asthma Guidance on routine self monitoring is not satisfactory

BMJ 1994;308:1099-1100 (23 April)

Letters

Caring for patients with asthma Guidance on routine self monitoring is not satisfactory

EDITOR, - The authors of the Grampian asthma study of integratedcare failed to provide convincing evidence that routine selfmonitoring of peak expiratory flow does not improve asthma morbidity.¹Several design flaws in the study related to power, patientselection, the intervention delivered, and outcome measuresneed discussing.

The power calculation is based on 569 subjects, but data isprovided for only 485 (239 monitoring peak expiratory flow,246 controls); what about the other 84 patients? The physicians'guidelines included two action levels depending on peak expiratoryflow: when to start oral steroids (for severe episodes of asthma)and when to seek medical assistance. Given that patients withmild asthma were selected (those possessing peak flow meterswere excluded from randomisation) and the weak power, the studydesign biased evaluation against effective routine self monitoringof peak expiratory flow.

At least four hospital centres (and an unstated number of . . . [Full text of this article]

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Relevant Article

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, and J G Douglas
BMJ 1994 308: 564-567. [Abstract] [Full Text]

This article has been cited by other articles:

Charlton, I, Charlton, G A, Jones, A, Drummond, N, Abdalla, M, Beattie, J, Russell, I, Friend, J, Legge, J, Douglas, G (1994). Caring for patients with asthma Teaching self management takes time. BMJ 308: 1370-1 [Full text]