Monitoring peak flow.

Abstract

.To the Editor:The title of the article by Malo et al., ″Should we monitor peak expiratory flow rates or record symptoms with a simple diary in the management of asthma?” (J ALLERGYCLINIMMUNOL1993;91:702-9) does not match its content. The authors compared the value of a symptom diary with a peak flow diary in the identification of asthma episodes. They did not compare the roles of symptom diaries and peak flow diaries in the overall management of asthma.The parents and patients in our practice have used peak flow–based diaries since 1981. They have found that peak flow monitoring helps them to:1.prevent asthma episodes2.learn the relationships between triggers, peak flow rates, symptoms, and episodes3.learn the efficacy and time course of various medicines4.taper medicines on a prudent timetable5.appreciate the value of environmental control6.delegate care of their child to a less experienced caretakerWe have analyzed thousands of peak flow–symptom diaries. We have found that nighttime cough and the other symptoms mentioned by Malo et al. almost always appear after the peak flow rate drops 20% from the patient's personal best.We base each asthma management plan on the individual patient's personal best peak flow rate. We define the personal best peak flow as the highest peak flow rate measured on two occasions after the airways have been cleared with a 7-day burst of prednisone and inhaled albuterol. Malo et al. established ″baseline” peak flow rates for each of their subjects over a 2-week period. We do not know the condition of the subjects' airways during that time. When the airways are inflamed, ″baseline” rates are almost always below the patient's personal best rate. An analysis of peak flow based on anything but the patient's personal best rate will often lead to flawed conclusions. .To the Editor:The title of the article by Malo et al., ″Should we monitor peak expiratory flow rates or record symptoms with a simple diary in the management of asthma?” (J ALLERGYCLINIMMUNOL1993;91:702-9) does not match its content. The authors compared the value of a symptom diary with a peak flow diary in the identification of asthma episodes. They did not compare the roles of symptom diaries and peak flow diaries in the overall management of asthma.The parents and patients in our practice have used peak flow–based diaries since 1981. They have found that peak flow monitoring helps them to:1.prevent asthma episodes2.learn the relationships between triggers, peak flow rates, symptoms, and episodes3.learn the efficacy and time course of various medicines4.taper medicines on a prudent timetable5.appreciate the value of environmental control6.delegate care of their child to a less experienced caretakerWe have analyzed thousands of peak flow–symptom diaries. We have found that nighttime cough and the other symptoms mentioned by Malo et al. almost always appear after the peak flow rate drops 20% from the patient's personal best.We base each asthma management plan on the individual patient's personal best peak flow rate. We define the personal best peak flow as the highest peak flow rate measured on two occasions after the airways have been cleared with a 7-day burst of prednisone and inhaled albuterol. Malo et al. established ″baseline” peak flow rates for each of their subjects over a 2-week period. We do not know the condition of the subjects' airways during that time. When the airways are inflamed, ″baseline” rates are almost always below the patient's personal best rate. An analysis of peak flow based on anything but the patient's personal best rate will often lead to flawed conclusions. To the Editor:The title of the article by Malo et al., ″Should we monitor peak expiratory flow rates or record symptoms with a simple diary in the management of asthma?” (J ALLERGYCLINIMMUNOL1993;91:702-9) does not match its content. The authors compared the value of a symptom diary with a peak flow diary in the identification of asthma episodes. They did not compare the roles of symptom diaries and peak flow diaries in the overall management of asthma.The parents and patients in our practice have used peak flow–based diaries since 1981. They have found that peak flow monitoring helps them to:1.prevent asthma episodes2.learn the relationships between triggers, peak flow rates, symptoms, and episodes3.learn the efficacy and time course of various medicines4.taper medicines on a prudent timetable5.appreciate the value of environmental control6.delegate care of their child to a less experienced caretakerWe have analyzed thousands of peak flow–symptom diaries. We have found that nighttime cough and the other symptoms mentioned by Malo et al. almost always appear after the peak flow rate drops 20% from the patient's personal best.We base each asthma management plan on the individual patient's personal best peak flow rate. We define the personal best peak flow as the highest peak flow rate measured on two occasions after the airways have been cleared with a 7-day burst of prednisone and inhaled albuterol. Malo et al. established ″baseline” peak flow rates for each of their subjects over a 2-week period. We do not know the condition of the subjects' airways during that time. When the airways are inflamed, ″baseline” rates are almost always below the patient's personal best rate. An analysis of peak flow based on anything but the patient's personal best rate will often lead to flawed conclusions. The title of the article by Malo et al., ″Should we monitor peak expiratory flow rates or record symptoms with a simple diary in the management of asthma?” (J ALLERGYCLINIMMUNOL1993;91:702-9) does not match its content. The authors compared the value of a symptom diary with a peak flow diary in the identification of asthma episodes. They did not compare the roles of symptom diaries and peak flow diaries in the overall management of asthma. The parents and patients in our practice have used peak flow–based diaries since 1981. They have found that peak flow monitoring helps them to: 1.prevent asthma episodes2.learn the relationships between triggers, peak flow rates, symptoms, and episodes3.learn the efficacy and time course of various medicines4.taper medicines on a prudent timetable5.appreciate the value of environmental control6.delegate care of their child to a less experienced caretaker We have analyzed thousands of peak flow–symptom diaries. We have found that nighttime cough and the other symptoms mentioned by Malo et al. almost always appear after the peak flow rate drops 20% from the patient's personal best. We base each asthma management plan on the individual patient's personal best peak flow rate. We define the personal best peak flow as the highest peak flow rate measured on two occasions after the airways have been cleared with a 7-day burst of prednisone and inhaled albuterol. Malo et al. established ″baseline” peak flow rates for each of their subjects over a 2-week period. We do not know the condition of the subjects' airways during that time. When the airways are inflamed, ″baseline” rates are almost always below the patient's personal best rate. An analysis of peak flow based on anything but the patient's personal best rate will often lead to flawed conclusions.