Robert L. Cowie, Shirley G. Revitt, Margot F. Underwood and Stephen K. Field Chest 1997;112;1534-1538 DOI 10.1378/chest.112.6.1534 The online version of this article, along with updated information and services can be found online on the World Wide Web at: http://chestjournal.chestpubs.org/content/112/6/1534Chest is the official journal of the American College of Chest Physicians. It has been published monthly since 1935. Copyright1997by the American College of Chest Physicians, 3300 Dundee Road, Northbrook, IL 60062. All rights reserved. No part of this article or PDF may be reproduced or distributed without the prior written permission of the copyright holder.(http://chestjournal.chestpubs.org/site/misc/reprints.xhtml) ISSN:0012-3692
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The Effect of a Peak Flow-Based Action Plan in the Prevention of Exacerbations of Asthma*
Robert L. Cowie, MD, MSc; and Stephen K. Field, MD
Shirley G. Revitt, RN; Margot F. Underwood, RN;
Study objective: To determine theeffect of a symptom-based and a peak flow-based action plan 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: Onehundred 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 and6 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.
(CHEST 1997; 112:1534-38)
Key words: action plan; asthma; emergency treatment;exacerbation; peak flow
now widely recommended that patients with asthma be provided with advice concerning the monitoring of their disease and with action plans to assist with adjustment of their therapy.1-4 Although some studies have demonstrated benefit from mon¬ itoring and self-management,56 others have shown that the benefit is limited7 or insignificant.810 We have been concerned that thesubgroup of asthmat¬ ics who seek urgent treatment for their disease might suffer from diminished awareness of their disease.11 This subgroup is known to be at increased risk of dying of asthma12 and clearly requires special atten¬ tion. We recruited asthmatic subjects who had re-
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quired urgent treatment for their disease and pro¬ vided them with basic information about asthmaand its treatment. These subjects were then randomly allocated to receive no action plan, a symptom-based action plan, or a peak expiratory flow-based action followed up for 6 months plan. the were of these interventions. In to deter¬ They mine impact particular, we wished to measure the impact on their need for urgent treatment of their asthma.
ment for their asthma in the