Asthma Management Handbook

Using other lung function tests in asthma review in adults

Recommendations

When reviewing asthma, do not use occasional office readings from a peak flow meter in place of spirometry to assess lung function.

How this recommendation was developed

Consensus

Based on clinical experience and expert opinion (informed by evidence, where available).

Consider asking patients to carry out 2–8 weeks of peak flow monitoring in these situations:

  • to help confirm the diagnosis of asthma
  • to help identify a trigger (e.g. in the diagnosis of work-related asthma)
  • to document improvement after starting treatment (where the benefit would outweigh the burden of monitoring)
  • to monitor safety after a planned dose reduction (especially in an anxious patient).

Notes

For patients with suspected work-related asthma, consider offering referral for specialist assessment as soon as possible.

Patients should record peak flow results on a chart in preference to a diary. Patients’ ability to recognise flare-ups depends on the proportions of the chart, so use the standardised National Asthma Council Australia and Woolcock Institute Peak Flow Chart 

How this recommendation was developed

Consensus

Based on clinical experience and expert opinion (informed by evidence, where available).

Consider long-term peak flow monitoring for patients with:

  • severe asthma
  • frequent or sudden flare-ups
  • poor perception of airflow limitation.
How this recommendation was developed

Consensus

Based on clinical experience and expert opinion (informed by evidence, where available).

If the person uses a peak flow meter to monitor asthma at home, ask them to bring their peak flow meter and their peak flow chart or diary to the review. Record any clinically important variation in lung function. Ask about the circumstances around the time of any apparent flare-ups. Regularly check the person’s peak flow measurement technique.

How this recommendation was developed

Consensus

Based on clinical experience and expert opinion (informed by evidence, where available).

When reviewing asthma, do not use occasional office readings from a hand-held lung function-measuring device (portable device that measures FEV1 and/or FEV6, but not FVC) to assess lung function in place of spirometry.

How this recommendation was developed

Consensus

Based on clinical experience and expert opinion (informed by evidence, where available).

More information

Self-monitoring in adults using peak expiratory flow

Peak flow monitoring is no longer routinely used in Australia, but is recommended for patients with severe asthma, a history of frequent flare-ups, or poor perception of airflow limitation.

Peak expiratory flow can be monitored at home using a mechanical or electronic peak flow meter, either regularly every day or when symptoms are worse. For patients who are willing to measure peak flow regularly, morning and evening readings can be plotted on a graph or recorded in a diary.

When peak flow monitoring results are recorded on a graph, the same chart should be used consistently so that patterns can be recognised. Flare-ups are easier to detect when the chart or image has a low ratio of width to height (aspect ratio), i.e. is compressed horizontally.1

When a person’s written asthma action plan is based on peak expiratory flow, instructions should be based on personal best, rather than predicted values. Personal best can be determined as the highest reading over the previous 2 weeks. When a person begins high-dose inhaled corticosteroid treatment, personal best peak expiratory flow reaches a plateau within a few weeks with twice daily monitoring.2

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References

  1. Jansen J, McCaffery KJ, Hayen A, et al. Impact of graphic format on perception of change in biological data: implications for health monitoring in conditions such as asthma. Prim Care Respir J. 2012; 21: 94-100. Available from: http://www.nature.com/articles/pcrj20124
  2. Reddel HK, Marks GB, Jenkins CR. When can personal best peak flow be determined for asthma action plans?. Thorax. 2004; 59: 922-4. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1746886/