A RANDOMIZED TRIAL COMPARING PEAK EXPIRATORY FLOW AND SYMPTOM SELF-MANAGEMENT PLANS FOR PATIENTS WITH ASTHMA ATTENDING A PRIMARY-CARE CLINIC

Great emphasis is placed on educating asthmatics to use action plans t o achieve better control of symptoms. The use of peak flow meters (PFM ) has been recommended as an important part of selfmanagement plans. W e studied 92 (47 F) adult patients with asthma in a primary care setti ng to compare the effectiveness of action plans using either peak flow monitoring or symptoms to guide self-management. Each patient was ins tructed in the use of the action plan in the context of a 6-mo asthma education program taught by a nurse. Patients were already using inhal ed corticosteroids or were newly prescribed corticosteroids by their f amily physician. Forty-four patients were randomized to the PFM group and 48 to the symptoms group. Spirometry, symptom scores, quality of l ife, medication use, and measures of health care utilization and morbi dity (emergency department visits, hospitalizations, unscheduled docto r visits, and days lost from work or school) were recorded at baseline and throughout the study period. PC,, methacholine was measured at th e first and at the final visits. There were significant improvements w ithin groups for FEV1, symptoms score, PC20 methacholine, and quality of life, but no between-group differences. A significant shift from hi gher to lower daily use of beta-agonists (p < 0.008 for both groups) a nd significant shifts to higher daily doses of inhaled steroids (p < 0 .001) occurred in each group. Adherence to the self-management plans w as only 65% in the PFM group and 52% in the symptoms group. Outcomes f or health care utilization were similar except for fewer patients maki ng unscheduled doctor visits within the PFM group. Our findings show t hat education, regular follow-up, and an action plan are effective in improving asthma control and quality of life, but the routine use of P FM to guide interventions is not the only way to accomplish these obje ctives.