Home Monitoring of Asthma: Symptoms and Peak Flow

Abstract

Monitoring is an established component of asthma control. Its purpose is to provide the patient an ongoing evaluation of the severity of the disease. The importance of such an evaluation cannot be overestimated as it guides corrective measures needed to keep asthma under control. All asthma patients monitor severity at some level, but only some do it systematically. The term ‘home monitoring’ implies the latter. It has been a part of asthma self-management programs since their inception. And while no one questions the necessity of monitoring for asthma control, its contribution to asthma self-management is not fully understood. Two forms of home monitoring have emerged: symptom monitoring and peak flow monitoring. Symptoms monitored include both subjective elements of an asthma exacerbation (i.e., dyspnea, chest tightness, cough, wheeze, and congestion), and objective indices of asthma severity such as activity limitation and nighttime awakenings. Respiratory indices monitored can include any of the several lung functions but only peak expiratory flow rate (PEFR) has been used widely. It is not uncommon for symptom and peak flow monitoring to be practiced together for asthma self-management. Despite the accepted value of monitoring, a great deal of interest has been devoted to examining the relative effectiveness of the two in asthma control. In this chapter, we describe common home monitoring practices and validation procedures, outline developments with potential to improve accuracy of symptom and PEFR indices, and review research on effectiveness of home monitoring in asthma self-management.