OBJECTIVE MEASUREMENTS OF COMPLIANCE IN ASTHMA-TREATMENT

Background: Self-management protocols and home peak expiratory flow ra te monitoring are thought to improve asthma care. Objective: Complianc e and accuracy of patients' record keeping were measured during a guid ed self-management protocol. Video, face-to-face instruction, and writ ten protocols were part of the educational program. Methods: Twenty pa tients participated in a 5-week study using memory capable peak expira tory flow rate meters and inhalers. During the baseline week all patie nts followed their customary approach to treatment and kept written di aries of peak expiratory flow rate and inhaler usage results thereafte r, they followed an individually designed self-management protocol. Re sults: Good technique and knowledge were found during the baseline vis it and improved by the last visit. Compliance with the protocol during the fifth week occurred in 40% of patients with underusage of inhaler s in 50% and overusage in 10% despite allowing for a 10% inaccuracy in recording, Patients keeping inaccurate records early in care tend not to improve. Errors in recording inhaler usage increased from 47% to 5 8% of days during the final week. Patients inflated peak expiratory fl ow rate scores (P <.01) over time. Slight improvement in the peak expi ratory flow rate was found for the entire group (baseline week 371 L/m in versus final week 386 L/min P <.05). Conclusions: Despite an extens ive educational program in the self-management of asthma, compliance w ith recommended treatment was only 40%. Electronic monitoring of peak expiratory flow rate and inhaler usage can provide early identificatio n of patients who do not comply,