Peak expiratory flow rate and symptom self-monitoring of asthma initiated from community pharmacies

Objective: To compare the use of patient-performed peak expiratory flow (PE FR) and symptom monitoring as asthma self-management tools initiated from c ommunity pharmacies. Design and setting. 110 patients over 6 years of age were recruited from fi ve private-sector community pharmacies. Patients were identified from pharm acist recall as having 'asthma. Information on the frequency of their asthm a symptoms, medication use, level of physical activity, school or work atte ndance and lung function was obtained using a questionnaire to classify pat ients as either mild, moderate or severe. Each patient was alternately assi gned to either the symptom or PEFR monitoring procedure in the order they w ere recruited. Patients performing symptom monitoring used a visual analogu e scale to assess symptoms, whereas those in the PEFR monitoring group asse ssed symptoms and used a pocket-size peak flow meter to measure lung functi on. Both self-monitoring groups were required to adhere to an individualize d management plan based on guideline recommendations and to record their mo nitored data in a diary card for 2 months. Data from the diary cards were r eviewed, collated, transcribed and analysed using the Student t and Mann-Wh itney tests. Outcome measures: The average monthly frequency of appropriate patient resp onses determined from their adherence to the selfmanagement plan was used t o compare the usefulness of symptom and PEFR self-monitoring. In particular , appropriate use of medication and need for medical consultation was compa red. Results: 21 symptom and 40 PEFR-assigned patients completed 2 months' monit oring. The average monthly frequency of appropriate responses in patients u sing PEFR (0.76) was significantly higher than that of patients using sympt om monitoring (0.53, P < 0.006). Patients applying symptom monitoring had a higher monthly frequency (0.39) of inappropriate medication use compared t o the PEFR group (0.14). Furthermore, the patients' mean daily symptom scor es (2.85) were significantly lower than that estimated by the researcher (4 .12, P < 0.03). For all three asthma severity groups a higher monthly avera ge of appropriate responses was observed in patients using PEFR monitoring compared to those who used symptom monitoring. Conclusion: PEFR self-monitoring proved to be a more useful asthma tool tha n symptom self-monitoring. Patients applying symptom monitoring tend to und erestimate the severity of their condition and use medication inappropriate ly. Active involvement of community pharmacists in facilitating and reinfor cing out-patient self-monitoring would help to optimize asthma management.