Peak expiratory flow rate monitoring can predict asthma exacerbation better as compared to monitoring by symptoms, prospective cohort study

Authors

  • Sarika Gupta Department of Pediatrics, KGMU, Lucknow, U. P., India
  • Shabnam Department of Pediatrics, KGMU, Lucknow, U. P., India
  • Ajay K. Verma Department of Respiratory Medicine, KGMU, Lucknow, U. P., India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20242730

Keywords:

Asthma, Exacerbation, Peak expiratory flow

Abstract

Background: Global initiative for asthma (GINA) guidelines suggest to use peak expiratory flow rate (PEFR) monitoring to assess response to treatment, to identify triggers for exacerbation and to have a baseline value for action plan (especially for the poor perceivers). In comparison to adults, there are less evidence in support of the routine use of PEFR recording for the diagnosis and monitoring level of control of asthma in children. This study was conducted with objective to assess the effect of PEFR monitoring on numbers of exacerbations in comparison to monitoring by symptoms in asthma.

Methods: This was a prospective cohort study done for a in department of pediatrics and respiratory medicine, of a tertiary care hospital, North India. Prior to recruitment ethical approval and informed consent/assent was taken. Study subjects were children with partial and uncontrolled asthma aged 5-12 years of age. Patients were divided into two groups on their first visit by using random allocation number. In group “A” monitoring was done with symptoms only, while in group “B” monitoring was done by symptoms and PEFR. Number of exacerbations during study period was noted. At baseline and follow up, CACT score was calculated. Spirometry was done at the end of 3 months.

Results: Group B had statistically significant lesser exacerbation during study period as compared to group A (OR=0.23; 95% CI=0.06-0.81; p=0.020).

Conclusions: PEFR based monitoring can be used as a potential tool for aborting or decreasing the severity of episodes of exacerbations of asthma especially in resource limited areas.

References

Global Initiative for Asthma. Global strategy for asthma management and prevention. 2020. Available at: www.ginasthma.org. Accessed on 15 June 2024.

Bheekie A, Syce JA, Weinberg EG. Peak expiratory flow rate and symptom self-monitoring of asthma initiated from community pharmacies. J Clin Pharm Ther. 2001;26:287-96.

Brouwer AF, Visser CA, Duiverman EJ, Roorda RJ, Brand PL. Is home spirometry useful in diagnosing asthma in children with nonspecific respiratory symptoms? Pediatr Pulmonol. 2010;45(4):326-32.

Ulrik C, OPostma D, Backer V. Recognition of asthma in adolescents and young adults: which objective measure is best? J Asthma. 2005;42(7):549-54.

Tsurikisawa N, Oshikata C, Sato T, Kimura G, Mizuki M, Tsuburai T, et al. Low Variability in peak expiratory flow predicts successful inhaled corticosteroid step-down in adults with asthma. J Allergy Clin Immunol Pract. 2018;6:972-9.

Kouri A, Gupta S, Yadollahi A, Ryan CM, Gershon AS, To T, et al. Addressing Reduced Laboratory-Based Pulmonary Function Testing During a Pandemic. Chest. 2020;158(6):2502-10.

Brouwer AF, Brand PL. Asthma education and monitoring: what has been shown to work. Paediatr Respir Rev. 2008;9(3):193-9.

Papadopoulos NG, Mathioudakis AG, Custovic A, Deschildre A, Phipatanakul W, Wong G, et al. PeARL collaborators, on behalf of the PeARL Think Tank. Childhood asthma outcomes during the COVID-19 pandemic: Findings from the PeARL multi-national cohort. Allergy. 2021;76(6):1765-75.

Awasthi S, Gupta S, Maurya N, Tripathi P, Dixit P, Sharma N. Environmental risk factors for persistent asthma in Lucknow. Indian J Pediatr. 2012;79(10):1311-7.

Graham BL, Steenbruggen I, Miller MR, Barjaktarevic IZ, Cooper BG, Hall GL, et al. Standardization of Spirometry 2019 Update. Am J Respir Crit Care Med. 2019;200(8):e70-88.

Liu AH, Robert Z, Christine S, Todd M, Nancy O, Somali B, et al. Development and cross-sectional validation of the Childhood Asthma Control Test. J Allerg Clin Immunol. 2007;119:817-25.

Aggarwal AN, Gupta D, Jindal SK. The relationship between FEV1 and peak expiratory flow in patients with airways obstruction is poor. Chest. 2006;130(5):1454-61.

Wensley D, Silverman M. Peak flow monitoring for guided self-management in childhood asthma: a randomized controlled trial. Am J Respir Crit Care Med. 2004;170(6):606-12.

Kamps AWA, Roorda RJ, Brand PLP. Peak flow diaries in childhood asthma are unreliable. Thorax 2001;56(3):180-2.

Powell H, Gibson P. Options for self-management education for adults with asthma. Cochrane Database Syst. Rev. 2003;1:CD004107.

Fonseca AC, Fonseca MT, Rodrigues ME, Lasmar LM, Camargos PA. Peak expiratory flow monitoring in asthmatic children. J Pediatr. 2006;82(6):465-9.

Zemek RL, Bhogal SK, Ducharme FM. Systematic review of randomized controlled trials examining written action plans in children: what is the plan? Arch Pediatr Adolesc Med. 2008;162(2):157-63.

Self TH, George CM, Wallace JL, Patterson SJ, Finch CK. Incorrect use of peak flow meters: are you observing your patients? J Asthma. 2014;51(6):566-72.

Ortega H, Menzies-Gow A, Llanos JP, Forshag M, Albers F, Gunsoy N, et al. Rapid and Consistent Improvements in Morning PEF in Patients with Severe Eosinophilic Asthma Treated with Mepolizumab. Adv Ther. 2018;35(7):1059-68.

Kim M, Kim YM, Lee JY, Yang HK, Kim H, Ahn S, et al. Seasonal and monthly variation in peak expiratory flow rate in children with asthma. Asia Pac Allergy. 2021;11(2):e19.

Tsurikisawa N, Oshikata C, Sato T, Kimura G, Mizuki M, Tsuburai T, et al. Low Variability in peak expiratory flow predicts successful inhaled corticosteroid step-down in adults with asthma. J Allergy Clin Immunol Pract. 2018;6(3):972-9.

WHO package of essential noncommunicable (PEN) disease interventions for primary health care. Geneva: World Health Organization, Licence: CC BY-NC-SA 3.0 IGO. 2020. Available at: http://gard-cplp.ihmt.unl.pt/Documentos/Publicacoes/2020_PEN.pdf.

Halpin DMG, Meltzer EO, Pisternick-Ruf W, Moroni-Zentgraf P, Engel M, Zaremba-Pechmann L, Casale T, FitzGerald JM. Peak expiratory flow as an endpoint for clinical trials in asthma: a comparison with FEV1. Respir Res. 2019;20(1):159.

Arnold DH, Lindsell CJ, Gong W, Daly CH, Hartert TV. Peak Expiratory Flow and Forced Expiratory Volume in 1 Second Percent Predicted Values Are Not Interchangeable Pediatric Asthma Exacerbation Severity Measures. Ann Am Thorac Soc. 2020;17(5):654-6.

Goodacre S, Bradburn M, Cohen J, Gray A, Benger J, Coats T, et al. Prediction of unsuccessful treatment in patients with severe acute asthma. Emerg Med J. 2014;31(e1):e40‑5.

Wu YF, Su MW, Chiang BL, Yao-Hsu Y, Ching-Hui T, Yungling LL. A simple prediction tool for inhaled corticosteroid response in asthmatic children. BMC Pulm Med. 2017;17(1):176.

Arnold DH, Lindsell CJ, Gong W, Daly CH, Hartert TV. Peak Expiratory Flow and Forced Expiratory Volume in 1 Second Percent Predicted Values Are Not Interchangeable Pediatric Asthma Exacerbation Severity Measures. Ann Am Thorac Soc. 2020;17(5):654-6.

Feldman JM, Kutner H, Matte L, Lupkin M, Seinberg D, Sidora-Arcoleo K, et al. Prediction of peak flow values followed by feedback improves perception of lung function and adherence to inhaled corticosteroids in children with asthma. Thorax. 2012;67(12):1040-5.

Cen J, Ma H, Chen Z, Weng L, Deng Z. Monitoring peak expiratory flow could predict COPD exacerbations: A prospective observational study. Respir Med. 2019;148:43-8.

Downloads

Published

2024-09-24

Issue

Section

Original Research Articles