PEAK EXPIRATORY FLOW METERS (PEFMS) - WHO USES THEM AND HOW AND DOES EDUCATION AFFECT THE PATTERN OF UTILIZATION

Background: Asthma control may be assisted by educating patients to us e peak expiratory flow meters (PEFMs). Aims: To find out the sociodemo graphic and clinical characteristics of asthmatics attending an Emerge ncy Room (ER) who owned PEFMs. Methods: We undertook a study of 352 as thmatics aged seven to 55 years who attended an ER. The following were analysed: their pattern of peak flow monitoring (PFM), the factors as sociated with 'appropriate' or daily PFM on entry to the study and the n prospectively; whether asthma education influenced utilisation and w hether there was a reduction in ER use or admissions in those who acqu ired a PEFM. Results: Those owning a PEFM at entry to the study (54%) had more asthma morbidity (p = 0.0001), had had asthma for longer (p = 0.0001), had seen their medical practitioners more often in the previ ous nine months (p = 0.0001), were on more asthma medications (p = 0.0 001) and were more likely to have been to an Asthma Clinic (p = 0.0001 ). Those not owning a PEFM were more likely to be of lower social clas s (p = 0.016) and of Pacific Island origin (p = 0.0001) suggesting tha t distribution is not ideal and is influenced by disease severity, amo unt of health care use and sociodemographics. Patients with a self-man agement plan (35% of PEFM owners) and those receiving 'good care' or m anagement, were more likely to use PFM 'appropriately' and to mention PFM in a scenario evaluating their response to worsening asthma contro l and argues for PEFMs to be distributed only in conjunction with a se lf-management plan, and therefore in close association with the patien ts' medical practitioners. Most patients (75%) appeared to prefer maki ng management decisions based on symptoms rather than on their peak ex piratory flow (PEF) and few (16%) performed daily PFM at entry to the study and fewer (6%) nine months later. There was an improvement in th e pattern of PFM after education, but the acquisition of a PEFM made n o difference to the frequency of ER use or admission. Conclusion: More realistic goals need to be defined in relationship to PFM which may i mprove patients' acceptance of the strategy, and therefore, hopefully their compliance. Such strategies need to be consistently reinforced o ver time for them to have an impact on asthma morbidity.