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Chest and TB Hospital, Patiala, India
PURPOSE: Several guidelines suggest the use of written self management plan using peak flow meter and/or symptom profile in the management of bronchial asthma. The present study was done to evaluate the effectiveness of such a tool.
METHODS: A randomized controlled trial was conducted on 100 patients. On the first visit the physician spent 45 minutes with each patient discussing the pathophysiology (using visual aids) and thus the need to take two types of medication, the chronic nature of the disease and the use of self management plan of bronchial asthma. The patients were followed monthly for 6 months and their asthma control monitored.
RESULTS: The increase in lung function parameters was comparable in both the groups. The default rates were also similar. The data on morbidity parameters was too scarce to make any meaningful comparisons. The physician was able to stop treatment in significant number of patients before the end of the study period because of the seasonal nature of their disease.
CONCLUSION: Providing a peak flow based self management plan did not confer any advantage to the group of patients studied.
CLINICAL IMPLICATIONS: An extended treatment protocol was not necessary for the majority of the patients. In these patients symptoms lasted for a limited period because of the seasonal nature of disease and it was difficult (high but similar default rates) and inadvisable to continue the treatment in such cases. The patients having chronic asthma and frequent exacerbations, poor perception of symptoms and frequent hospitalizations might be the ones who benefit from peak flow based self management plan.
DISCLOSURE: H.S. Sangha, None.
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