Reddel H K, Marks G B, Jenkins C R
Woolcock Institute of Medical Research, Camperdown, NSW, Australia.
Thorax. 2004 Nov;59(11):922-4. doi: 10.1136/thx.2004.023077.
Written asthma action plans based on personal best peak expiratory flow (PEF) consistently improve health outcomes, whereas those based on predicted PEF do not. Guidelines state that personal best PEF should be assessed over 2-3 weeks during good asthma control, but it is unclear how long to wait after commencing or changing treatment.
Electronically recorded spirometric data from 61 subjects with initially poorly controlled asthma from a 72 week budesonide study were analysed. For each week, average morning pre-bronchodilator PEF was calculated and personal best PEF was determined as the highest PEF in the previous 2 weeks. The time to plateau was defined as the week beyond which no further improvement occurred.
At baseline, average morning PEF was 61% predicted and personal best PEF was 87% predicted. Personal best PEF from twice daily monitoring increased to a plateau of 95% predicted (p<0.0001) after only 3 weeks of budesonide treatment. However, average morning PEF continued to improve for 3 months and "as needed" reliever use for 7 months.
Personal best PEF is a useful concept for asthma self-management plans when determined as the highest PEF over the previous 2 weeks. With twice daily monitoring, personal best PEF reaches plateau levels after only a few weeks of corticosteroid treatment.
基于个人最佳呼气峰值流速（PEF）制定的书面哮喘行动计划能持续改善健康状况，而基于预测PEF的计划则不然。指南指出，应在哮喘控制良好的2 - 3周内评估个人最佳PEF，但开始治疗或改变治疗方案后要等待多长时间尚不清楚。
分析了来自一项为期72周的布地奈德研究中61名初始哮喘控制不佳的受试者的电子记录肺功能数据。每周计算平均晨起支气管扩张剂前PEF，并将个人最佳PEF确定为前2周内的最高PEF。将达到平台期的时间定义为之后不再有进一步改善的周数。
基线时，平均晨起PEF为预测值的61%，个人最佳PEF为预测值的87%。布地奈德治疗仅3周后，每日两次监测得到的个人最佳PEF升至预测值的95%的平台期（p<0.0001）。然而，平均晨起PEF持续改善3个月，“按需”使用缓解药物的情况持续改善7个月。
当将个人最佳PEF确定为前2周内的最高PEF时，它是哮喘自我管理计划中的一个有用概念。通过每日两次监测，个人最佳PEF在皮质类固醇治疗仅几周后就达到平台期水平。
