Skip to main content
SpringerLink
Log in

Assessing symptoms and peak expiratory flow rate as predictors of asthma exacerbations

  • Original Articles
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

An Erratum to this article was published on 01 August 2004

Abstract

OBJECTIVE: To investigate peak expiratory flow rate (PEFR) and quality of life scores for their ability to predict exacerbations of asthma.

PARTICIPANTS AND METHODS: We identified adults who received oral or inhaled asthma medications from 36 community drugstores. We administered the McMaster Asthma Quality of Life Questionnaire (AQLQ) and measured PEFR, defining “red zone” (highest risk) as a PEFR <50% of each patient’s expected value based on gender, age, and height. We identified asthma exacerbations (breathing-related emergency department visits and hospitalizations) within 4 and 12 months after enrollment and used proportional hazards regression to assess the ability of PEFR and AQLQ scores to predict exacerbations, controlling for clinical and demographic factors.

RESULTS: A red zone PEFR was a significant universiable predictor of exacerbations within 12 months (hazard ratio [HR], 1.8; 95% confidence interval [CI], 1.1 to 3.0; P=.027). However, neither a red zone PEFR, the raw PEFR, or percent of predicted maximal PEFR were significantly predictive when controlling for AQLQ scores, clinical characteristics, or demographic data (P<.2). However, the 4 subscales of the AQLQ were each significant univariable and multivariable predictors of asthma exacerbations. For example, the overall AQLQ scale had a multivariable HR of 0.63 (95% CI, 0.46 to 0.87; P=.005) for exacerbations occurring within 4 months and 0.66 (95% CI, 0.54 to 0.82; P<.001) within 12 months.

CONCLUSIONS: PEFR added no predictive information to that contained in AQLQ scores and clinical and demographic data. These results support the National Institutes of Health asthma guidelines’ recommendation for routinely assessing symptoms but not PEFR.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Weiss ST. Asthma: Epidemiology. In: Fiskman’s Pulmonary Diseases and Disorders, 3rd edn. New York, NY: McGraw-Hill; 1998:735–43.

    Google Scholar 

  2. Mannino DM, Homa DM, Pertowski CA, et al. Surveillance for Asthma—United States 1960–1995. MMWR CDC Surveill Summ. 1998;47:1–27.

    PubMed  CAS  Google Scholar 

  3. National Heart, Lung, and Blood Institute. National Institutes of Health. Data Fact Sheet: Asthma Statistics. Available at: http://www.nhlbi.nih.gov/health/prof/lung/asthma/asthstat.pdf. Accessed January 9, 2003.

    Google Scholar 

  4. Fish JE, Peters SP. Asthma: clinical presentation and management. In: Fiskman’s Pulmonary Diseases and Disorders, 3rd edn. New York, NY: McGraw-Hill; 1998:757–75.

    Google Scholar 

  5. Donahue JG, Weiss ST, Livingston JM, Goetsch MA, Greineder DK, Platt R. Inhaled steroids and the risk of hospitalization for asthma. JAMA. 1997;277:887–91.

    Article  PubMed  CAS  Google Scholar 

  6. Blaiss L, Suissa S, Boivin JF, Ernst P. First treatment with inhaled corticosteroids and the prevention of admissions to hospitals for asthma. Thorax. 1998;53:1025–9.

    Article  Google Scholar 

  7. Barnes PJ, Jonsson B, Klim JB. The costs of asthma. Eur Respir J. 1996;9:636–42.

    Article  PubMed  CAS  Google Scholar 

  8. Balkrishnan R, Norwood GJ, Anderson A. Outcomes and cost benefits associated with the introduction of inhaled corticosteroid therapy in a Medicaid population of asthmatic patients. Clin Ther. 1998;20:567–80.

    Article  PubMed  CAS  Google Scholar 

  9. American Thoracic Society. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease (COPD) and asthma. Am Rev Respir Dis. 1987;136:225–44.

    Google Scholar 

  10. Jain P, Kavuru MS, Emerman CL, Ahmad M. Utility of peak expiratory flow monitoring. Chest. 1998;114:861–76.

    PubMed  CAS  Google Scholar 

  11. Expert Panel Report 2. Guidelines for the Diagnosis and Management of Asthma. National Heart, Lung, and Blood Institute. National Institutes of Health Publication no. 97-4051; 1997.

  12. Richards JM, Hemstreet MP. Measures of life quality, role performance and functional status in asthma research. Am J Respir Crit Care Med. 1994;149:S31-S9.

    PubMed  Google Scholar 

  13. Weinberger M, Murray MD, Marrero DG, et al. A pharmaceutical care program for patients with reactive airway disease. Am J Health Sys Pharm. 2001;58:791–6.

    CAS  Google Scholar 

  14. Weinberger M, Murray MD, Marrero DG, et al. The effectiveness of pharmaceutical care for patients with reactive airways disease: a randomized, controlled trial in community pharmacies. JAMA. 2002;288:1594–602.

    Article  PubMed  Google Scholar 

  15. Badgett RG, Tanaka DJ, Hunt DK, et al. The clinical evaluation for diagnosing obstructive airways disease in high-risk patients. Chest. 1994;106:1427–31.

    PubMed  CAS  Google Scholar 

  16. Steiner J, Koepsell T, Fihn S, Inui T. A general method of compliance assessment using centralized pharmacy records. Description and validation. Med Care. 1988;26:814–23.

    Article  PubMed  CAS  Google Scholar 

  17. Juniper EF, Guyatt GH, Epstein RS, Ferrie PJ, Jaeschke R, Hiller TK. Evaluation of impairment of health related quality of life in asthma: development of a questionnaire for use in clinical trial. Thorax. 1992;47:76–83.

    PubMed  CAS  Google Scholar 

  18. Juniper EF, Guyatt GH, Ferrie PJ, Griffith LE. Measuring quality of life in asthma. Am Rev Respir Dis. 1993;147:832–8.

    PubMed  CAS  Google Scholar 

  19. McDonald CJ, Overhage JM, Tierney WM, et al. The Regenstrief Medical Record System: a quarter century experience. Int J Med Inf. 1999;54:225–53.

    Article  CAS  Google Scholar 

  20. Nunn AJ, Gregg I. New regression equations for predicting peak expiratory flow in adults. Br Med J. 1989;298:1068–70.

    Article  CAS  Google Scholar 

  21. SAS. Version 6.12. SAS Institute Inc., Cary, NC.

  22. Rutten-van Molken MPMH, Custers F, Van Doorslaer EKA, et al. Comparison of performance of four instruments in evaluating the effects of salmeterol on asthma quality of life. Eur Respir J. 1995;8:888–98.

    PubMed  CAS  Google Scholar 

  23. Gruffydd-Jones K. Quality of life measures in asthma—do they matter to the GP?. Br J General Pract. 1997;47:392–4.

    CAS  Google Scholar 

  24. Juniper EF, Guyatt GH, Willan A, Griffith LE. Determining a minimally important change in a disease-specific quality of life questionnaire. J Clin Epidemiol. 1994;47:81–7.

    Article  PubMed  CAS  Google Scholar 

  25. Couturaud F, Proust A, Frachon I, et al. Education and self-management: a one-year randomized trial in stable adult asthmatic patients. J Asthma. 2002;39:493–500.

    Article  PubMed  CAS  Google Scholar 

  26. Toelle BG, Ram FS. Written individualised management plans for asthma in children and adults. Cochrane Database Syst Rev 2002:CD002171.

  27. Kamps AW, Brand PL. Education, self-management and home peak flow monitoring in childhood asthma. Paediatr Repair Rev. 2001;2:165–9.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Received from the Division of General Internal Medicine and Geriatrics, USA

    William M. Tierney MD & Morris Weinberger PhD

  2. Department of Medicine, Indiana University School of Medicine, USA

    Michael D. Murray PharmD, MPH

  3. Regenstrief Institute for Health Care, USA

    William M. Tierney MD, Michael D. Murray PharmD, MPH & Morris Weinberger PhD

  4. Roudebush VA Medical Center, USA

    William M. Tierney MD & Morris Weinberger PhD

  5. Division of Pulmonary, Allergy, Critical Care, and Occupational Medicine, USA

    J. Franklin Roesner MD & Michael G. Lykens MD

  6. Department of Medicine, Indiana University School of Medicine, USA

    Roopa Seshadri PhD & Michael D. Murray PharmD, MPH

  7. Division of Biostatistics, USA

    Roopa Seshadri PhD

  8. Purdue University School of Pharmacy and Pharmacal Sciences, Indianapolis, Ind

    Michael D. Murray PharmD, MPH

Authors
  1. William M. Tierney MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Franklin Roesner MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Roopa Seshadri PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michael G. Lykens MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael D. Murray PharmD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Morris Weinberger PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to William M. Tierney MD.

Additional information

This study was supported by grant HS-09083 from the Agency for Healthcare Research and Quality. Dr. Roesner was supported by training grant T32-HL07774 from the National Heart, Lung, and Blood Institute.

An erratum to this article is available at http://dx.doi.org/10.1111/j.1525-1497.2004.04198.x.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tierney, W.M., Roesner, J.F., Seshadri, R. et al. Assessing symptoms and peak expiratory flow rate as predictors of asthma exacerbations. J GEN INTERN MED 19, 237–242 (2004). https://doi.org/10.1111/j.1525-1497.2004.30311.x

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1111/j.1525-1497.2004.30311.x

Key Words

Search

Navigation