Jones K P, Mullee M A, Middleton M, Chapman E, Holgate S T
Primary Medical Care Group, University of Southampton, UK.
Thorax. 1995 Aug;50(8):851-7. doi: 10.1136/thx.50.8.851.
Peak flow based asthma self-management plans have been strongly advocated in consensus statements, but convincing evidence for the effectiveness of this approach has been largely lacking.
A randomised controlled trial was conducted in 25 general practices comparing an asthma self-management programme based on home peak flow monitoring and surgery review by a general practitioner or practice nurse with a programme of planned visits for surgery review only over a six month period.
Seventy two subjects (33 in the self-management group and 39 in the planned visit group) completed the study protocol, but diary card data for at least three months were available on a total of 84 (39 in the self-management group and 45 in the planned visit group). Teaching self-management took longer than the planned visit review. In the self-management group home peak flow monitoring was felt to be useful by doctors and patients in 28 (85%) and 27 (82%) cases, respectively. There were no between group differences during the study period in terms of lung function, symptoms, quality of life, and prescribing costs. Only within the self-management group were improvements noted in disturbance of daily activities and quality of life. Possible explanations for these negative results include small numbers of subjects, the mild nature of their asthma, and inappropriate self-management strategies for such patients.
Rigid adherence to long term daily peak flow measurement in the management of mild asthma in general practice does not appear to produce large changes in outcomes. Self-management and the use of prescribed peak flow meters need to be tailored to individual circumstances.
基于峰值流速的哮喘自我管理计划在共识声明中得到了大力倡导，但这种方法有效性的令人信服的证据在很大程度上一直缺乏。
在25家普通诊所进行了一项随机对照试验，比较了基于家庭峰值流速监测以及由全科医生或执业护士进行复诊的哮喘自我管理计划与仅进行计划性复诊的计划，为期六个月。
72名受试者（自我管理组33名，计划性复诊组39名）完成了研究方案，但总共84名受试者（自我管理组39名，计划性复诊组45名）至少有三个月的日记卡数据可用。教授自我管理比计划性复诊花费的时间更长。在自我管理组中，医生和患者分别认为28例（85%）和27例（82%）的家庭峰值流速监测是有用的。在研究期间，两组在肺功能、症状、生活质量和开药费用方面没有差异。仅在自我管理组中，日常活动干扰和生活质量有改善。这些负面结果的可能解释包括受试者数量少、哮喘病情较轻以及针对此类患者的自我管理策略不当。
在普通实践中，严格坚持在轻度哮喘管理中进行长期每日峰值流速测量似乎不会使结果产生大的变化。自我管理和使用规定的峰值流速仪需要根据个体情况进行调整。
