Related Experiment Video
Updated: Aug 24, 2026
Symptom Assessment of Patients with Allergic Rhinitis Using an Allergen Exposure Chamber
Published on: March 3, 2023
Peak flow monitoring for guided self-management in childhood asthma: a randomized controlled trial
Diane Wensley1, Mike Silverman
1Department of Child Health and Institute for Lung Health, University of Leicester, Leicester, United Kingdom.
Insights
Adding peak expiratory flow (PEF) monitoring to asthma self-management plans did not improve outcomes in school children. Symptom-based management alone was as effective as PEF-guided management for controlling asthma symptoms.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Clinical Trial Research
Background:
- Asthma self-management in school children often relies on symptom monitoring.
- Peak expiratory flow (PEF) monitoring is a potential tool to enhance asthma control.
- The added benefit of PEF recordings to symptom-based plans requires further investigation.
Purpose of the Study:
- To evaluate if incorporating PEF recordings into a symptom-based self-management plan improves outcomes in school children with moderate asthma.
- To compare the effectiveness of PEF-guided management versus symptom-based management alone.
Main Methods:
- An open-randomized, parallel-group, controlled trial involving 90 children aged 7-14 years with moderate asthma.
- Participants were randomized to receive either PEF plus symptom-based management or symptom-based management alone for 12 weeks.
- Home spirometry for PEF monitoring and symptom diaries were used, with predefined thresholds for medication adjustments based on PEF values.
Main Results:
- No significant differences were observed between the groups in mean daily symptom scores, spirometric lung function, PEF values, or quality of life scores over 12 weeks.
- Health service utilization also showed no significant between-group differences.
- During acute exacerbations, children adjusted inhaled steroids based on symptoms rather than PEF thresholds, indicating PEF did not influence self-management decisions.
Conclusions:
- The addition of PEF recordings to a symptom-based self-management plan did not enhance asthma control or self-management in school children.
- Symptom-based management alone appears to be as effective as PEF-guided management for this population.
- Further research may explore optimal strategies for integrating objective measures into pediatric asthma self-management.
Abstract:
We asked whether the addition of PEF recordings to a symptom-based self-management plan improved outcome in school children with asthma. In an open-randomized, parallel-group, controlled trial, we studied children aged 7-14 years with moderate asthma. After a 4-week run-in, 90 children were randomized to receive either PEF plus symptom-based management or symptom-based management alone for 12 weeks. Thresholds for action based on PEF were 70% of best (for increasing inhaled steroids) and 50% of best (for commencing prednisolone). Children were asked to perform twice-daily spirometry at home (using an electronic recording spirometer that revealed only PEF to the study group alone) and to record a symptom diary. The mean daily symptom score was the main outcome. There were no differences between groups in mean symptom score or in spirometric lung function, PEF, quality of life score, or reported use of health services over 12 weeks. During acute episodes, children responded to changes in symptoms by increasing their inhaled steroids at a mean value of PEF of greater than 70% of best so that overall PEF did not contribute to this important self-management decision. Knowledge of PEF did not enhance self-management even during acute exacerbations.
Related Concept Videos
01:30Asthma-IV: Nursing Management
First, in...
01:30Asthma-IV: Diagnostic and Management
Clinical Assessment for Asthma:
This is the first step in diagnosing and managing asthma. It includes:
01:25Pulmonary Function Tests
Pulmonary Function Tests are crucial diagnostic tools for assessing respiratory function, particularly in patients with chronic respiratory disorders. They comprehensively evaluate lung volumes, ventilatory function, breathing mechanics, diffusion, and gas exchange. These tests help diagnose pulmonary diseases and play a significant role in monitoring disease progression, evaluating disability, and assessing response to therapy.
PFTs involve using a spirometer, a...