Home Peak Flow Research Articles

Home dampness and respiratory health status in european children.

Living in a damp home has been associated with impaired respiratory health in previous studies, but objective data on lung function variability and atopy have been lacking from most studies. Data collected in the winter of 1993-1994 in the framework of the PEACE study (Pollution Effects on Asthmatic Children in Europe) were used to study the association between home dampness and Peak Flow (PEF) variability, frequency of respiratory symptoms and relief medication use during the period of observation. Children were selected with a screening questionnaire on the basis of positive answers to questions on symptoms of asthma and chronic cough. Children were instructed to perform PEF measurements with Miniwright PEF meters twice daily over a period of 2 months. Parents kept diaries on respiratory symptoms and medication use of their children. Data on demographic and housing characteristics were derived from a parent-administered questionnaire. As indicators for home dampness reported moisture stains and moulds were used. Children were tested for atopy with skin-prick tests. Data from 1614 children from 13 centres in 10 different countries were available for analysis. Linear regression models and prevalence rate ratios were used to investigate the association between home dampness and PEF variability and the period prevalence of cough, phlegm, lower and upper respiratory symptoms and bronchodilator use. In atopic children, PEF variability was positively related to self-reported moulds but not to moisture stains. The period prevalence of cough and upper respiratory symptoms was significantly higher in children living in houses with reported moulds, compared with 'dry' homes. These results show that self-reported moulds in homes are associated with objective as well as subjective markers of airway lability in European children with chronic respiratory symptoms.

Evaluation and outcome of patients with chronic non-productive cough using a comprehensive diagnostic protocol

BACKGROUNDAsthma, post-nasal drip syndrome (PNDS), and gastro-oesophageal reflux (GOR) account for many cases of chronic non-productive cough (CNPC). Each may simultaneously contribute to cough even when clinically silent, and failure...

Parental Perceptions of Access to Care and Quality of Care for Inner-City Children with Asthma

The objective of this study was to describe perceptions of asthma care, morbidity, and health service utilization by parents of children with asthma presenting to an inner-city emergency department (ED). A cross-sectional survey was conducted in an urban pediatric ED, with a convenience sample of 466 parents of children receiving asthma treatment during a consecutive 6-week period in late fall 1995. Parents completed a 30-item survey including sociodemographic data, source of primary medical care and asthma care for their child, selected measures of access to care, and medications used by their child in the week prior to the ED visit. Perceived quality of asthma care was measured by six items (summary score = 0-6) reported to have been performed by the child's asthma doctor: discussion of home peak flow monitoring, child-specific triggers, dogs/cats, smoke, postexacerbation calling instructions, and provision of a written asthma management plan. Functional morbidity was measured by nights of poor sleep, days of cough, and school days missed due to asthma in the previous month. Among 325 patients with previously diagnosed asthma, 308 (97%) were reported to have a source of primary medical care. Of these, 126 respondents identified their primary care provider as the child's usual source of asthma care, while 158 identified the ED as the usual source. The groups did not differ by insurance status, ethnicity, or mean age of the child. Thirty-nine percent of children with the same provider for primary and asthma care compared with 15% of children reported to receive their asthma care predominantly in the ED had used inhaled steroids or cromolyn in the week prior to the ED visit (p < .0001). Children with the same provider for primary and asthma care had a higher mean quality score than children receiving asthma care in the ED (3.7 vs. 2.8, p < 0.0001), but there was no relationship between source of asthma care and functional morbidity. The ED remains the usual source of asthma care for many inner-city children. Among parents surveyed in the ED, there was a significant relationship between source of usual asthma care and quality of care, but a relationship between usual source of asthma care and functional morbidity could not be identified.

1. The patient with chronic cough

The most effective management of cough is specific therapy, which results in a greater than 90% response rate, so the cause should be thoroughly investigated. A chest x-ray should be taken early in the clinical investigation of chronic cough. The three most common causes of chronic cough when chest x-rays are normal are postnasal drip, bronchial asthma and gastro-oesophageal reflux. Chronic cough has more than one cause in 20% of patients, so therapy may need to be directed at multiple causes. Gastro-oesophageal reflux may complicate cough from any cause because a cough-reflux feedback cycle can develop. Hence, a four-week trial of an H2-receptor antagonist is indicated in patients with unexplained chronic cough where the history, physical examination, chest x-ray, lung function tests, ear/nose/throat examination and home peak flow monitoring all fail to elucidate a cause. Non-specific therapy should be reserved for when no diagnosis can be made, or when therapy is likely to be ineffective (e.g., lung malignancy).

Asthma: Recent trends in diagnosis and management

Asthma is an inflammatory disease of the airways that results in airway hyperreactivity and episodic airway narrowing. The prevalence of asthma in the United States is increasing, as are the rates of morbidity and mortality associated with the disease. Environmental and psychosocialfactors may be responsible for these disturbing trends and should be modified when possible. Psychiatrists should be able to diagnose and to manage uncomplicated cases of asthma because of certain risk factors such as cigarette smoke, emotional distress, and severe psychiatric illness. Anti-inflammatory and bronchodilator medications are the foundation of pharmacologic treatment. To increase compliance, patient education is critical. The clinician should encourage careful self-monitoring and use of a home peak flow meter. Every attempt should be made to modify adverse environmental factors. Recent cellular and molecular research has led to a better understanding of the pathophysiology of asthma. As a result of this increasing understanding, newer medications are being developed and tested. The new “antimediator” agents, which appear to be effective and safe for the treatment of asthma, are particularly promising.

ABC of Asthma: CHRONIC ASTHMA--GENERAL MANAGEMENT

Obvious precipitating factors should be sought and avoided when practicable. This is possible for specific allergens such as animals and foods, but is not usually feasible with more widespread allergens such as pollens and house dust mites. A common non-specific stimulus is cigarette smoking. Up to a fifth of asthmatics continue to smoke andstrenuous efforts should be made to discourage smoking in both asthmatic patients and their families. Precipitating factors should be carefully explored on one of the first visits but they should also be reassessed periodically. Fortunately most asthmatic patients can have their disease controlled by safe drug treatment with minimal side effects. Education of the patient in understanding the disease and treatment is often helped by home peak flow recording and written explanations of the purpose and practical details of treatment. In particular, the differences between symptomatic bronchodilator treatment and regular maintenance treatment must be emphasised. It is all too common to find asthmatic patients using their dose of inhaled steroid or sodium cromoglycate only to treat an acute attack. Trained nurses can be helpful in continuing education and supervision. Many hospitals have concentrated their patients into specific asthma clinics for …

The incidence of airflow obstruction in bronchial carcinoma, its relation to breathlessness, and response to bronchodilator therapy

Breathlessness is a common symptom in patients with primary bronchial carcinoma and is often not well-controlled. Most patients are ex- or current smokers, and therefore are at high risk for co-existing chronic obstructive pulmonary disease (COPD). The incidence of airflow obstruction in patients with bronchial carcinoma, its relation to breathlessness, and response to bronchodilator therapy was examined prospectively. Fifty-seven consecutive patients attending our outpatient clinic with bronchial carcinoma diagnosed in the preceding 12 months were studied (22 female, 35 male, mean age 68·4 years). Spirometry was performed and breathlessness rated. Those with airflow obstruction (FEV 1:FVC<65% and FEV 1<70% predicted) and who judged themselves to have moderate or severe breathlessness, were offered a trial of bronchodilator therapy. The response to regular inhaled fenoterol and ipratropium bromide by metered dose inhaler (MDI) and large volume spacer, and to regular nebulized salbutamol and ipratropium bromide was assessed by home peak flow recordings, spirometry and two subjective scores: (a) rating of breathlessness on a simple four-point scale, and (b) activity score of the St George's Respiratory Questionnaire. There was very strong association between airflow obstruction and breathlessness. Twenty-eight patients (49%) had airflow obstruction, and we had breathlessness ratings on 26 of these patients of whom 18 (69%) had rated it as moderate or severe. Only four of the patients with airflow obstruction and breathlessness were using broncholdilator therapy. There was no significant difference in the mean age, time from diagnosis, tumour site, or smoking history between the groups with, and without, airflow obstruction. There was no association between cell type and the presence of airflow obstruction. Seventeen patients accepted the offer of a trial of bronchodilator therapy, of whom 15 patients remained well enough to complete it. Home peak expiratory flow rate (PEFR), rose from 233 1 min −1 to 247 1 min −1 with MDI bronchodilators, and to 256 1 min −1 with nebulized bronchodilators. Mean FEV 1 rose from 1·181 to 1·31 1 following 2 weeks of MDI bronchodilators, and to 1·351 with nebulized drugs. For the group, there was no additional benefit from nebulized drugs over the MDI. Eight patients showed objective improvement — PEFR and/or FEV 1 increasing by >15% of baseline. Nine patients felt that their breathing had been helped ‘quite a lot’ or ‘a great deal’, but four patients had not experienced objective benefit. Breathlessness rating improved significantly following bronchodilators, falling from 2·53 pre-treatment to 1·87 following MDI use, and to 1·79 with nebulized drugs. There was no significant improvement in mean activity scores. We conclude that untreated airflow obstruction is commonly present in patients with bronchial carcinoma, is strongly associated with breathlessness, and that these patients may benefit from simple bronchodilator treatment.

ALLERGIST INFLUENCE IN ASTHMA CARE

Purpose of the Study. To determine whether care by an allergist reduces the morbidity for asthma specifically by decreasing the need for hospitalizations and emergency room visits. Methods. This was a retrospective chart review of patients first seen between June 1985 and June 1986 and followed the second year either in an allergy clinic or in a general pediatric clinic. Charts were analyzed for demographic information; information regarding hospitalizalions, emergency room visits, and intensive care unit admissions; medications, including bronchodilators, systemic steroids and inhaled steroids, and home nebulizer; and home peak flow meters. There were 209 charts reviewed initially. Of these, 83 patients were then followed by allergists, 40 by non-allergists, and 86 were lost to followup. Findings. There was no statistically significant difference in patient characteristics of asthma at baseline, except that those followed by allergists had a significant increase in the use of oral steroids. There was a significant difference in favor of the allergy followup group for decrease in hospitalization rate and emergency room visits. In terms of medication, there was no significant difference in the use of theophylline, beta2-agonists, or home nebulizers, but there was a statistically significant increase in the use of cromolyn sodium and inhaled steroids, the use of spacers for the metered-dose inhalers, use of home peak flow monitoring, and a decreased incidence of intensive care admissions. Interestingly, there was no change in pets or smoking in the children's environment. Reviewer's Comments. This study suggests that the followup of asthmatics by an allergist is superior to the non-allergist.

HOW USEFUL DO PARENTS FIND HOME PEAK FLOW MONITORING FOR CHILDREN WITH ASTHMA?

Purpose of the Study. This study seeks to assess the actual utility of the home peak flow meter (PFM). Methods. In a clinic where all children aged over 5 years receive a peak flow meter, 50 consecutive outpatients' families were given a questionnaire to explore the knowledge of the family consequent to the use of the PFM and their assessment of its utility. Findings. Eighty-four percent of the 50 respondents were familiar with key PFM parameters for their child, and 70% rated the PPM as very useful, another 28% as useful, and one patient as useless. Eighty-eight percent found the PPM useful during an attack of asthma; 46% as useful in assessing the response to bronchodilator therapy. A finding in a small number (20%) of detecting asthma in asymptomatic patients, is also of significance. Conclusion and Comments. These findings support the usefulness of the PPM in home management of asthma in children. There remains some debate over whether its use should be stressed for asthma attacks and asymptomatic patients; some feel that patients should be taught to assess how asthma interferes with their daily life to best judge asthma's need for treatment. This study would have been more useful if such a group had been compared to the PFM group. I personally find that patients are increasingly technology-oriented and use the PFM in the home management of asthma.

Parents favour home peak flow

Parents favour home peak flow

How useful do parents find home peak flow monitoring for children with asthma?

How useful do parents find home peak flow monitoring for children with asthma?

International consensus report on diagnosis and management of asthma

International consensus report on diagnosis and management of asthma

Failure of Inhaled Corticosteroids to Modify Bronchoconstrictor or Bronchodilator Responsiveness in Middle-Aged Smokers with Mild Airflow Obstruction

We have compared the effects of three-month periods of treatment with an inhaled corticosteroid, budesonide 600 micrograms twice daily and with placebo on bronchial responses to inhaled histamine and to bronchodilators in a double-blind crossover trial in 14 middle-aged male smokers (mean age, 59.6 years) with mild airways obstruction (mean FEV1 2.42 L, 80 percent predicted [range, 48 to 110 percent]). Responsiveness to inhaled histamine was assessed monthly by the provocative concentration (mg/ml) reducing FEV1 by 20 percent (PC20). Bronchodilator response to a combination of inhaled salbutamol (5 mg) and ipratropium (0.5 mg) was assessed before and after three months' treatment. Compliance with treatment was checked by weighing aerosol canisters, and by measuring plasma budesonide and metabolites. There was no significant change in FEV1 (budesonide mean 2.38 L [SEM 0.17] vs placebo 2.40 L [0.17]), vital capacity (budesonide mean 3.69 L [0.17] vs placebo 3.81 L [0.17]) or in bronchodilator responsiveness (mean increase over baseline FEV1, budesonide 11.6 [2.7] percent vs placebo 10.5 [3.2] percent). There was a small overall reduction in bronchoconstrictor responsiveness over the period of the trial, but there was no effect of 12 weeks of budesonide treatment compared with 12 weeks of placebo treatment (mean log PC20 during budesonide 0.595 [SEM 0.063], placebo 0.591 [SEM 0.055]). Following the three-month crossover trial, six men continued for nine more months to receive budesonide in a single-blind trial and the results were compared with those in six men who took no active treatment for the subsequent nine months. No improvements in baseline spirometry, home peak flow measurements, bronchoconstrictor or bronchodilator responsiveness were observed after 12 months of budesonide treatment. Thus, a regimen of budesonide treatment that consistently attenuates bronchial responsiveness in asthmatic subjects had no effect in these men; larger and longer trials will be required to establish whether a subgroup of smokers shows a favorable response.

Home peak flow meters.

Home peak flow meters.

Home peak flow meters

Home peak flow meters

Home peak flow meters.

Home peak flow meters.

791 Longitudinal study of home peak flow variability in childhood asthma

791 Longitudinal study of home peak flow variability in childhood asthma