Usefulness of monitoring lung function in asthma

• Published in: Archives of disease in childhood Vol. 88; no. 11; pp. 1021 - 1025
• Main Authors: Brand, P L P, Roorda, R J
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health 01.11.2003; BMJ; BMJ Publishing Group Ltd; BMJ Publishing Group LTD
• Subjects: Adults; Airway management; airways hyperresponsiveness; Analysis; Asthma; Asthma - physiopathology; Asthma in children; Biological and medical sciences; Bronchial Hyperreactivity - diagnosis; Care and treatment; Child; Childhood asthma; Children; Chronic obstructive pulmonary disease, asthma; Clinical Experience; Clinical medicine; Clinical trials; Diagnosis; Diaries; Diseases; Evidence; FEV; forced expiratory volume; Guidelines; Health aspects; Home Care Services; Humans; Hypotheses; Lung; Lung - physiopathology; lung function; Lungs; mean expiratory flow; Medical examination; Medical sciences; MEF; Methods; Monitoring; Nitric oxide; Patient monitoring; Patients; peak expiratory flow; Peak Expiratory Flow Rate; Pediatric diseases; PEF; Personal Practice; Physiologic monitoring; Physiological aspects; Pneumology; Prevention; Respiratory function; Respiratory Function Tests - methods; Self Care - methods; Self Management; Sick children; Studies; Teaching Methods; United Kingdom; Human; Lung disease; Pediatrics; Lung function; Surveillance; Respiratory disease; Bronchus disease; Obstructive pulmonary disease; Review; Child; Monitoring; Asthma
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/adc.88.11.1021

There is no firm evidence from randomised controlled trials that routine monitoring of lung function improves asthma control in children. Guidelines for management of asthma consistently recommend routine home monitoring of peak expiratory flow (PEF) in each patient. However, changes in PEF poorly reflect changes in asthma activity, PEF diaries are kept very unreliably, and self management programmes including PEF monitoring are no more effective than programmes solely based on education and symptom monitoring. PEF diaries may still be useful in isolated cases of diagnostic uncertainty, in the identification of exacerbating factors, and in the rare case of children perceiving airways obstruction poorly and exacerbating frequently and severely. If a reliable assessment of airways obstruction in asthma is needed, forced expiratory flow-volume curves are the preferred method. Monitoring of hyperresponsiveness and nitric oxide cannot be recommended for routine use at present. Clinical judgement and expiratory flow-volume loops remain the cornerstone of monitoring asthma in secondary care.