PEAK FLOW BASED ASTHMA SELF-MANAGEMENT - A RANDOMIZED CONTROLLED-STUDY IN GENERAL-PRACTICE

Background - Peak flow based asthma self-management plans have been st rongly advocated in consensus statements, but convincing: evidence for the effectiveness of this approach has been largely lacking. Methods - A randomised controlled trial was conducted in 25 general practices comparing an asthma self-management programme based on home peak flow monitoring and surgery review by a general practitioner or practice nu rse with a programme of planned visits for surgery review only over a six month period. Results - Seventy two subjects (33 in the self-manag ement group and 39 in the planned visit group) completed the study pro tocol, but diary card data for at least three months were available on a total of 84 (39 in the self-management group and 45 in the planned visit group). Teaching self-management took longer than the planned vi sit review. In the self-management group home peak flow monitoring was felt to be useful by doctors and patients in 28 (85%) and 27 (82%) ca ses, respectively. There were no between group differences during the study period in terms of lung function, symptoms, quality of life, and prescribing costs. Only within the self-management group were improve ments noted in disturbance of daily activities :md quality of life. Po ssible explanations for these negative results include small numbers o f subjects, the mild nature of their asthma, and inappropriate self-ma nagement strategies for such patients. Conclusions - Rigid adherence t o long term daily peak flow measurement in the management of mild asth ma in general practice does not appear to produce large changes in out comes. Self-management and the use of prescribed peak flow meters need to be tailored to individual circumstances.