clinical trial evaluating the effects of three different intensities
of asthma symptom monitoring: subjective symptom monitoring (group 1),
peak flow use when symptomatic (group 2), and peak flow use BID and
when symptomatic (group 3).1
were age 6 to 19 and had more than three asthma-related visits in the
year preceeding the study. Nurses visited the participants' homes and
gathered sociodemographic data, baseline information regarding asthma
morbidity, current medication use, and spirometry data. Participants
were them given a journal and asked to keep symptoms for three months
before being randomized into one of the three groups using a stratified
randomization procedure. All groups received asthma action plans, asthma
education and training in symptom recognition.
Results were monitored by three months of diary keeping, an exit interview
at 3 months, and a 1 year post-exit interview. A chart reviewed was
also performed to determine health care utilization.
comparison of symptom scores at the three month exit interview revealed
that group two had more symptom improvement than group one (p=0.10),
group three had more symptom improvement than group one (p=0.13), and
group three had more improvement than group two (p=0.002). The only
one of these effects that was sustained at one year was group two had
more symptom improvement than group one (p=0.07), although this was
not clinically significant. When the groups were broken down into categories
based on race, both groups two and three were shown to have significantly
more improvement in symptoms at one year than group one (p = 0.004 and
0.05 respecitively.) Only six percent of people in group three reported
continued BID use of the peak flow meter at one year.
visits (ER and clinic) decreased from one year pre to one year post
study. The most dramatic increase was in group two, who had a decline
from 3.1 visits per year to 1.85 visits per year. Although this decrease
was almost two-fold greater than in the other groups, the difference
was not clinically significant.