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Peak flow diaries in childhood asthma are unreliable
A W Kamps1, R J Roorda, P L Brand
1Department of Paediatrics, Division of Paediatric Pulmonology, Isala Klinieken, Weezenlanden Hospital, PO Box 10500, 8000 GM Zwolle, The Netherlands.
Insights
Peak flow diaries are unreliable for monitoring childhood asthma. Electronic peak flow meters offer a more accurate solution for tracking asthma control in children.
Area of Science:
- Pediatric Pulmonology
- Asthma Management
- Biomedical Engineering
Background:
- Childhood asthma necessitates accurate monitoring for effective management.
- Peak expiratory flow rate (PEFR) monitoring is a key component of asthma care.
- The reliability of traditional peak flow diaries in pediatric populations is questionable.
Purpose of the Study:
- To assess the compliance and accuracy of peak flow diaries in children with asthma.
- To compare self-reported peak flow data with electronically recorded data.
- To determine the most reliable method for peak flow monitoring in pediatric asthma.
Main Methods:
- Forty asthmatic children (ages 5-16) used electronic peak flow meters and written diaries for 4 weeks.
- Participants were unaware the electronic device stored data on a microchip.
- Two groups received different motivational messages regarding the importance of accurate recording.
- Written diary data (reported) were compared against electronic meter data (actual).
Main Results:
- Actual compliance with peak flow monitoring (77.1%) was significantly lower than reported compliance (95.7%).
- Accuracy of peak flow entries decreased over the study period, with an increase in fabricated entries.
- Discrepancies between written and electronic entries were substantial, ranging from -72 to 34 L/min.
Conclusions:
- Peak flow diaries are unreliable for monitoring asthma in children.
- Electronic peak flow meters are recommended for accurate peak flow monitoring in pediatric asthma patients.
Background:
A study was undertaken to investigate the compliance with and accuracy of peak flow diaries in childhood asthma.
Methods:
Forty asthmatic children (5-16 years) were asked to perform peak flow measurements twice daily for 4 weeks by means of an electronic peak flow meter and to record values in a written diary. Patients and parents were unaware that the device stored the peak flow values on a microchip. In random order, half of the patients were only told that the device allowed for more accurate assessment of peak flow while the other half were told that accurate recording of peak flow was important because the results would be used in guiding adjustments to treatment. Data in the written diary (reported data) were compared with those from the electronic diary (actual data).
Results:
In the entire study population the mean (SD) actual compliance (77.1 (20.5)%) was much lower than the mean reported compliance (95.7 (9.1)%) (95% CI for difference 12.7% to 24.4%) The percentage of correct peak flow entries decreased from 56% to <50% from the first to the last study week (p<0.04), mainly as a result of an increase in self-invented peak flow entries. Results were comparable for both groups. For incorrect peak flow entries the mean difference between written and electronically recorded entries ranged from -72 to 34 l/min per patient.
Conclusions:
Peak flow diaries kept by asthmatic children are unreliable. Electronic peak flow meters should be used if peak flow monitoring is required in children with asthma.