Peak Flow Use Research Articles

Adherence to National Asthma Guidelines in the Acute Care Setting: A Retrospective Cohort Study.

Peak flow is a crucial but simple test used to categorize the severity of an episode of an acute exacerbation of asthma.It should be regularly done in all the patients who present with asthma acute exacerbation in the emergency department. The British Thoracic Society (BTS)/Scottish Intercollegiate Guidelines Network (SIGN) guidelines stipulate peak flow use as one of the main tools to categorize acute asthma into moderate, severe, and life-threatening asthma. The BTS and SIGN guidelines also state peak flow is to be utilized in monitoring the disease and to guide in treating patients with acute asthma. This study aims to identify the adherence to BTS/SIGN guidelines around the use of peak expiratory flow rate (PEFR) in assessing the severity of patients presenting with acute exacerbation of asthma in a district general hospital. The retrospective cohort study involved collating data between October 2022 and February 2023 from our hospital electronic system. The data collected about the use of PEFR and whether the patients were being classified by severity in presentation following this was compared to the BTS/SIGN 158 asthma guidelines. Following this, the data analysis was done using IBM SPSS Statistics for Windows, Version 21.0 (Released 2012; IBM Corp., Armonk, New York, United States). Data from 92 patients were collated. PEFR was recorded for 29.3% (n=27) of patients and acute exacerbation of asthma severity was documented in merely 17.4% (n=16) patients. The results indicate a significant proportion of the patient cohort analyzed did not have peak flow readings, there is clear room for improvement, and further intervention is needed in order for the department to adhere to the gold standard guidelines (i.e., BTS/SIGN 158), and thus improve the management and monitoring of acute asthma exacerbations. Future directions can include departmental education, posters as a reminder, and prompts on the electronic system used to alert users to check PEFR when a diagnosis of acute asthma exacerbation is documented.

Findings from a community-based asthma education fair for Latino caregivers

Objective: To assess limited English proficiency (LEP) asthma caregiver quality of life (QoL), skills retention and healthcare utilization after an asthma education fair (AEF). Methods: A language concordant AEF was conducted at a Latino community center. LEP caregivers of children 1–12 years old and an established asthma diagnosis participated in three skill stations: (a) medication recognition and administration, (b) peak flow use (if child ≥ 5 years) and (c) action plan dissemination. Spacers, peak flow meters and individualized action plans were distributed. A validated, pediatric asthma caregiver quality of life questionnaire (PACQLQ-Spanish version) was administered. Baseline data was compared to follow-up interview data at three and six months after the AEF. Mean PACQLQ scores were analyzed with Wilcoxon signed-rank test and nominal paired data with McNemar’s test. Results: We analyzed data from 18 caregivers able to speak English well (22%), not well (28%) or not at all (50%). After three months, improved caregiver QoL was experienced (51 vs. 72, p < 0.01). No differences were observed in medication recognition, spacer and peak flow use or peak flow interpretation. After six months, mean school days missed due to asthma decreased (4.1 vs. 0.4, p < 0.01). Mean clinic visits, emergency department visits and hospitalizations remained unchanged. Conclusions: Implementation of a community-based AEF with action plan administration can be beneficial for LEP caregivers and their children. QoL improvements to emotional wellbeing and activity limitations were observed, and lower rates of school absenteeism were reported. Caregiver ability to accurately identify medications was not enhanced.

Relationship Between the Use of Asthma Action Plans and Asthma Exacerbations in Children With Asthma

The purpose of this integrative review is to describe and assess current research findings and summarize the relationship between action plans and asthma exacerbations in children with asthma. Medline, CINAHL Plus with full text, PubMed, and Cochrane Library databases were searched as well as bibliographies of included studies. Three hundred eighty-five studies were identified. Thirteen studies were identified meeting inclusion criteria. Eight studies compared asthma action plans (AAPs) with no AAPs. Five studies compared peak flow AAPs to symptom AAPs. Of the 8 studies comparing AAPs with no AAPs, 5 studies concluded that the plans were beneficial to pediatric asthma. One study concluded that AAPs may increase risk for readmission to the hospital. Another study concluded that there is no evidence to suggest that AAPs along with an educational package were beneficial in reducing morbidity in the subsequent 12 months for preschoolers. A third study concluded there were greater costs in the group with AAPs without better outcomes. Of the 5 studies comparing peak flow AAPs with symptom AAPs, 3 studies found that AAPs are effective for pediatric patients but there is no benefit of peak flow AAPs over symptom AAPs. Two studies found that peak flow meter use along with an AAP was a more effective way to decrease hospitalizations. Data suggest that AAPs are beneficial to pediatric asthma patients. Either peak flow–based or symptom-based plans are effective in the control of asthma exacerbations. However, there does not appear to be evidence to support the use of peak flow–based AAPs over symptom-based AAPs.

Reporting peak expiratory flow in older persons.

Peak expiratory flow ("peak flow") predicts important outcomes in older persons. Nevertheless, its clinical application is uncertain because prior strategies for reporting peak flow may not be valid. We thus determined the frequency distribution of peak flow by the conventional strategy of percent predicted (%predicted) and by an alternative method termed standardized residual (SR) percentile, and evaluated how these two metrics relate to health status in older persons. Participants included 754 community-dwelling persons aged >/= 70 years. Data included chronic conditions, frailty indicators, and peak flow. Mean age was 78.4 years, with 63.7% reporting a smoking history, 17.4% chronic lung disease, and 77.1% having one or more frailty indicators. Peak flow >/= 80 %predicted was recorded in 67.5% of participants, whereas peak flow >/= 80th SR percentile was only noted in 15.9%. A graded relationship was observed between peak flow and health status, but %predicted yielded health risk at peak flows currently considered normal (80-100 %predicted), whereas SR percentile conferred health risk only at severely reduced peak flows (< 50th SR percentile). Peak flow expressed as SR percentile attains a frequency distribution more consistent with the characteristics of our elderly cohort, and establishes health risk at more appropriate levels of reduced peak flow. These findings establish the need for longitudinal studies based on SR percentile to further evaluate the use of peak flow as a risk assessment tool in older persons and to determine if pulmonary function, in general, is better reported in older persons as SR percentile, rather than as %predicted.

The use of peak flow during acute exacerbations of chronic obstructive pulmonary disease in the emergency department

Study objectives: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a common complaint for emergency department (ED) patients, accounting for 110,000 deaths and 500,000 hospitalizations annually. The forced expiratory volume in 1 second (FEV1) has been used for years as a reliable clinical outcome predictor of morbidity and mortality in patients with stable COPD, and several studies have shown that peak expiratory flow (PEF) values and FEV1 have good correlation during AECOPD. Recent reviews of the literature have not revealed a useful clinical predictor for the outcome risk or relapse risk in the acute setting. We proposed that a 35% improvement in PEF as a response to bronchodilator therapy can predict those patients with AECOPD who may be successfully discharged from the ED. Methods: Patients older than 50 years and with a history of COPD presenting to a large, academic ED with worsening dyspnea, increase in sputum volume, or increase in sputum purulence were prospectively enrolled by a physician, nurse, or licensed vocational nurse during a 7-month period. A chest radiograph and ECG were obtained on arrival. An initial PEF value was recorded (the best of 3 measurements). Two albuterol (2.5 mg) and Atrovent (0.5 mg) in 2 μL of saline nebulizer treatments were administered 10 to 20 minutes apart, followed by 50 mg of oral prednisone or 125 mg of intravenous Solu-Medrol and intravenous or oral antibiotics. A posttreatment PEF value was recorded (best of 3 measurements) 60 to 90 minutes after initiation of bronchodilator therapy. Additional therapy was administered at the physician's discretion. Patients stable for discharge were given 50 mg of oral prednisone for 5 days, as well as an antibiotic chosen by the treating physician, and received telephone follow-up within 10 days of discharge. Those patients who were admitted, returned to the ED, or had an unscheduled primary care visit due to persistent or worsening symptoms were considered to be outpatient treatment failures. Results: During a 9-month period, 19 patients were enrolled. There was no significant difference between the first and last peak flow within the unsuccessfully treated group ( P >.01) on the paired t test. There was a significant difference between the first and last peak flow within the successfully treated group ( P =.008) on the paired t test. There was no significant difference in first peak flows between outcome groups ( P >.01) on the independent samples t test. There was no significant difference in last peak flows between outcome groups ( P >.01) on the independent samples t test. Conclusion: There is no statistical difference in the response to ED treatment of AECOPD by measuring PEF between patients successfully treated as outpatients and those who were admitted or failed outpatient therapy.

Do school-based health centers provide adequate asthma care?

School-based health centers (SBHCs) are increasingly charged with providing primary care services including asthma care. This study assessed SBHC provider adherence to the National Heart, Lung, and Blood Institute (NHLBI) asthma care guidelines and the association among provider adherence, patient characteristics, and asthma outcomes. A cross-sectional study design was used to assess SBHC chart data from 415 children with asthma attending four inner-city elementary schools (K-5) in the Bronx, NY. Asthma symptoms, peak flow use, follow-up visits, and referrals to asthma specialists were documented in the charts of 60%, 51%, 22%, and 3% of subjects, respectively. Thirty-three percent of charts had SBHC clinician-documented severity classifications, of which 70% had appropriate medications prescribed. Asthma education and an asthma plan were documented in 18% and 10% of charts, respectively. Environmental triggers and tobacco exposures were documented in 71% and 49% of charts, respectively. Older children (> 8 years) were more likely to have documentation of peak flow use for asthma management, asthma education, follow-up visits, and written asthma plans, whereas younger children (< 8 years) were more likely to miss more days of school (all p < .05). Overall, provider adherence to NHLBI guidelines was inadequate, with adherence somewhat better for older children.

An evaluation of the action plans of children with asthma

To assess the provision and use of action plans in children attending hospital because of asthma. An interviewer administered a structured questionnaire to the parents of 279 children attending the Casualty Department, Outpatient clinics or admitted to hospital because of asthma, at two Level 3 teaching hospitals. Only 82 (29%) of the children attending hospital had a written action plan. The majority (57%) were devised by paediatricians and covered the salient aspects of care. However, indications for steroid use were included in only 28% of plans and only 37% of the action plans in children over 5 years incorporated the use of peak flow meters. Action plans are still under-utilized in children with asthma. General practitioners should be encouraged to consider the use of action plans for the group of children not already covered.