Is peak flow monitoring superior to symptom-based monitoring in improving outcomes in patients using asthma action plans?

From the Guidelines

Peak flow monitoring is not clearly superior to symptom-based monitoring for most patients using asthma action plans, and the choice between the two should be individualized based on patient preference and characteristics. Both approaches are effective, and symptom-based monitoring (tracking cough, wheeze, chest tightness, and shortness of breath) is sufficient for most patients and may lead to better adherence due to its simplicity 1. Peak flow monitoring, which uses a peak flow meter to measure how fast air can be blown out of the lungs, may be particularly beneficial for patients who have difficulty perceiving worsening symptoms, those with severe or unstable asthma, or those with a history of sudden severe exacerbations 1.

Key Considerations for Peak Flow Monitoring

• Patients should establish their personal best value when asthma is well-controlled, then use a traffic light system: green zone (80-100% of personal best) indicates good control, yellow zone (50-80%) signals caution and the need for rescue medication, and red zone (below 50%) requires immediate medical attention.
• The effectiveness of either approach depends on proper education, consistent use, and appropriate response to changes in symptoms or peak flow values.
• Peak flow diaries are a practical alternative for monitoring asthma, especially in cases where spirometry and fractional exhaled nitric oxide (FeNO) are not widely available 1.

Recommendations for Clinical Practice

• Symptoms and lung function represent different domains of asthma, and they correlate poorly over time in individual patients, so both need to be monitored by clinicians assessing asthma control in clinical practice 1.
• Long-term diaries are not needed for the clinical management of asthma in the majority of patients, but may be relevant in “poor perceivers” (patients who have difficulty sensing airway obstruction) or patients with frequent exacerbations 1.
• The most important factor is that patients have some form of monitoring integrated into a comprehensive written asthma action plan that they understand and can follow.

From the Research

Peak Flow Monitoring vs Symptom-Based Monitoring

• Peak flow monitoring has been compared to symptom-based monitoring in several studies to determine its effectiveness in improving outcomes in patients using asthma action plans 2, 3.
• A randomized trial found that while both peak flow monitoring and symptom-based monitoring improved asthma control and quality of life, there were no significant between-group differences in terms of FEV1, symptom scores, and quality of life 2.
• The study also found that adherence to self-management plans was lower in both groups, with only 65% adherence in the peak flow monitoring group and 52% in the symptom-based monitoring group 2.
• Another study recommended the use of peak flow monitoring as part of a written action plan for effective asthma management, but did not provide direct comparison with symptom-based monitoring 3.

Outcomes and Healthcare Utilization

• The study by 2 found that outcomes for healthcare utilization were similar between the two groups, except for fewer patients making unscheduled doctor visits in the peak flow monitoring group.
• Other studies have focused on the importance of inhaled corticosteroids and combination therapies in improving asthma outcomes, but did not directly compare peak flow monitoring and symptom-based monitoring 4, 5.
• The use of peak flow monitoring in clinical practice and clinical asthma trials has been reviewed, highlighting the need for improved criteria for diagnosing exacerbations and standardized user-friendly peak flow charts 6.

Asthma Management and Action Plans

• Asthma management guidelines recommend the use of inhaled corticosteroids, combination therapies, and written action plans for effective management of asthma 4, 5.
• Peak flow monitoring can be a useful tool in asthma management, but its effectiveness compared to symptom-based monitoring is still a topic of debate 2, 3.
• Further research is needed to determine the optimal approach to asthma monitoring and management, including the role of peak flow monitoring and symptom-based monitoring in improving patient outcomes 2, 6.