Guided self‐care using daily recording of peak expiratory flow and diary description for chronic airflow obstruction in the elderly

Abstract

Background:Only a few studies have been reported concerning the effects of guided self‐care programs on elderly patients with chronic airflow obstruction; chronic obstructive pulmonary disease (COPD); and bronchial asthma (BA). The purpose of the present paper was to study the usefulness of guided self‐care in elderly patients with COPD or BA using a diary alone or diary plus daily measurement of peak expiratory flow rate (PEFR).Methods:A prospective and randomized study was performed at the Pulmonary Division of the Tokyo Metropolitan Geriatric Hospital. A total of 212 patients (mean age: 76.6 years) with a clinical diagnosis of COPD or BA with mild or no cognitive impairment was studied. All patients were randomly assigned to one of two groups: group I (diary and measurement of daily PEFR; n = 112) or group II (diary alone; n = 100).Results:There was no significant difference in the mean number of admissions per month between groups I and II. However, the mean duration of hospitalization was shorter in group I (P < 0.05). The group I COPD subjects had fewer (P < 0.05) and shorter (P < 0.02) periods of admission compared with the group II COPD subjects. This remained true after adjusting for gender, age and forced expiratory volume in 1 s (FEV1.0), but there was no such difference observed for BA subjects. Among subjects in group II, those with COPD showed significantly longer periods of admission than BA subjects (P < 0.05). Better compliance with the PEFR description in group I correlated significantly with the shorter mean duration of hospitalization in the group with higher compliance. This was not found in group II (diary alone). Poor compliance was significantly correlated with advancing age (P < 0.04). However, this was not the case for compliance with the diary. Male subjects showed significantly better compliance in diary description than female subjects (P < 0.04).Conclusions:The PEFR recording plus diary notations are useful tools for avoiding hospitalizations due to acute exacerbation of COPD and probably BA in elderly patients. However, a possible limitation is that fewer than half of elderly COPD and BA patients with mild or no cognitive impairment appear to be able to record PEFR properly.