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ARTICLE

Using Quality-Control Analysis of Peak Expiratory Flow Recordings To Guide Therapy for Asthma

Peter G. Gibson, MBBS, FRACP; John Wlodarczyk, PhD; Michael J. Hensley, MBBS, PhD, FRACP, FAFPHM; Keith Murree-Allen, MBBS, FRACP, FCCP; Leslie G. BSc(Med) Olson, MBBS, PhD, FRACP; and Nicholas Saltos, MBBS, FRACP, FCCP, FRCP

1 October 1995 | Volume 123 Issue 7 | Pages 488-492

Objective: To compare the action points in published asthma management plans with those derived from quality-control analysis of peak expiratory flow recordings.

Design: Longitudinal observational study.

Setting: An ambulatory asthma education and management program in a tertiary care hospital.

Patients: 35 adults with asthma and exacerbation of asthma.

Measurements: Peak expiratory flow diaries and symptom recordings.

Results: Asthma action points from published asthma management guidelines had poor operating characteristics. The success rate was 35% when the action point was a peak expiratory flow rate less than 60% of the patient's best peak flow. The success rate improved to 88% when the action point was a peak expiratory flow rate less than 80% of the patient's best peak flow. Published action points had a high failure rate. Peak flow decreased to below the published action points during a stable period of asthma in 7% to 51% of patients studied. Action points defined using quality-control analysis did significantly better. A peak flow value less than 3 standard deviations below the patient's mean peak flow detected 84% of exacerbations and had a low failure rate (19%). Other quality-control tests had sensitivities of 91% and 71%. Quality-control action points could detect exacerbations up to 4.5 days earlier than conventional methods.

Conclusions: Individualized action points can be derived for patients with asthma by applying quality-control analysis to peak flow recordings. These action points are more sensitive in detecting exacerbations of asthma and have fewer false-positive results. Action plans developed in this manner should be more useful for the early detection of deteriorating asthma.

Author and Article Information

From John Hunter Hospital, the University of Newcastle, and Royal Newcastle Hospital, Newcastle, New South Wales, Australia.
Acknowledgments: The authors thank the educators in the Asthma Management Service: Sr. P. Talbot, Sr. R. Toneguzzi, Sr. C. Kessell, and Mrs. P. Pratt. They also thank Gaye Sheather for secretarial assistance.
Grant Support: In part by the Asthma Foundation of New South Wales.
Requests for Reprints: Peter G. Gibson, Respiratory Medicine Unit, John Hunter Hospital, Locked Bag 1, Hunter Mail Exchange, Newcastle 2310, New South Wales, Australia.
Current Author Addresses: Drs. Gibson, Murree-Allen, Olson, and Saltos: Respiratory Medicine Unit, John Hunter Hospital, Locked Bag 1, Hunter Mail Exchange, Newcastle 2310, New South Wales, Australia.

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