Chest
Volume 112, Issue 6, December 1997, Pages 1534-1538
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Clinical Investigations: Asthma
The Effect of a Peak Flow-Based Action Plan in the Prevention of Exacerbations of Asthma

https://doi.org/10.1378/chest.112.6.1534Get rights and content

Study objective

To determine the effect of a symptom-based and a peak flow-based action plan in preventing acute exacerbations in subjects with poorly controlled asthma.

Design

A randomized controlled trial in which subjects who had required urgent treatment for their asthma were allocated to receive no action plan, a symptom-based plan, or a peak flow-based action plan.

Setting

A university hospital asthma clinic.

Population

One hundred fifty subjects were recruited after attending an emergency department or a clinic for urgent treatment of asthma.

Interventions

All subjects received evaluation and education for asthma before being randomly allocated to receive no action plan, a symptom-based action plan, or a peak flowmeter and a peak flow-based action plan.

Measurements

Subjects were assessed by questionnaire at 3 and 6 months after enrollment with questions relating to their asthma control and their need for urgent treatment or hospital admission for asthma.

Results

At 6 months after enrollment, although all three intervention groups experienced improvement in their asthma control, there was a striking reduction in emergency department visits for asthma only in the peak flow-based action plan group (p=0.006). No significant difference in emergency visits was apparent between the symptom-based action plan and no action plan groups.

Conclusions

We conclude that a peak flow-based action plan is effective, at least in the short term, in protecting patients with asthma against severe exacerbations of their disease.

Section snippets

Materials and Methods

Adult and adolescent patients who had received urgent treatment for their asthma in the preceding 12 months were invited to participate in this study. Subjects were recruited by contacting those who had been treated for an exacerbation of asthma in an emergency department in one of the teaching hospitals in the city of Calgary. Subjects were also recruited from those attending a university asthma clinic when they gave a history of having received urgent treatment for their asthma in the

Results

One hundred fifty-one subjects, of whom all had required urgent treatment for their asthma within the previous 12 months, were enrolled in the study. One subject was withdrawn when her physician revised her diagnosis following a normal methacholine challenge. In total, the remaining 150 subjects had required urgent treatment for asthma on 482 occasions and had been admitted to a hospital for treatment of asthma 71 times in the year preceding their entry into the study. Fifty-two of the subjects

Discussion

The implementation of action plans based on symptom or peak flow monitoring has been widely advocated for the management of asthma. Such an intervention, if effective, would seem to be clearly justified in those asthmatics who have severe exacerbations that require urgent treatment. The need for urgent asthma treatment might identify a subset of asthmatics who may be at increased risk of dying of their disease.11, 12 It has been postulated that this group of asthmatic subjects might lack

References (19)

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Supported by a grant from the Foothills Hospital, Calgary.

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