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SCH Journal Club 26 th March 2013

Prediction of peak flow values followed by feedback improves perception of lung function and adherence to inhaled corticosteroids in children with asthma. SCH Journal Club 26 th March 2013. Aim. To determine whether predicting peak flow value and comparing with actual peak flow

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SCH Journal Club 26 th March 2013

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  1. Prediction of peak flow values followed by feedback improves perception of lung function and adherence to inhaled corticosteroids in children with asthma SCH Journal Club 26th March 2013

  2. Aim To determine whether predicting peak flow value and comparing with actual peak flow value in asthmatic children will improve perception of their lung function

  3. Objectives • Search literature for relevant paper • Critically appraise the paper using CASP framework • Determine validity of paper • Assess whether able to apply to clinical practice

  4. Clinical Scenario 10 year old boy known to have poor control of his asthma attends the respiratory clinic for routine review. He is noted to have had several admissions to hospital since his last review despite maximal treatment, always attending with either acute severe or life-threatening symptoms.

  5. Background • Many factors can contribute to the poor control of asthma • One such factor which has been shown to contribute is the discrepancy between objective measures of airway obstruction and symptom perception. • This can result in a delay in seeking treatment for acute exacerbations due to an under-perception of the degree of bronchoconstriction

  6. Question Arising Does our patient’s perception of his symptoms correlate with the level of his lung function and is he able to recognise when his lung function has become compromised? If not is there a proven way to improve his perception of lung function thereby improving the control of his asthma and reducing his acute admissions to hospital?

  7. Clinical Question

  8. Literature Search [asthma] AND [perception OR awareness] AND [(lung AND function) OR (airway AND obstruction)] AND [(hospital OR (secondary AND care) OR (emergency AND healthcare)]. Limited to [child 0 – 18 years AND English language]

  9. Prediction of peak flow values followed by feedback improves perception of lung function and adherence to inhaled corticosteroids in children with asthma Jonathan M Feldman, Haley Kutner, Lynne matte, Michelle Lupkin, Dara Steinberg, Kimberly Sidora-Arcoleo, Denise Serebrisky, Karen Warman Thorax 2012;67:1040 - 1045

  10. Method Patients recruited from asthma clinics, primary care clinics, ED and mailings Restricted to Puerto Rican, African-American and Afro-Caribbean ethnic groups Confirmed diagnosis of asthma with breathing difficulties in past year Exclusion criteria included cognitive learning disability, vocal cord dysfunction, inability to conduct spirometry

  11. Figure 1 Asthma risk grid (adapted with permission from OceanSide Publications, Inc from Klein et al18). Accurate zone: boxes 1, 5, 9 and ±10% wedge; magnification zone: boxes 2, 3 and 6; danger zone: boxes 4, 7 and 8. PEF, peak expiratory flow.

  12. Outcome Measures 1.Asthma Risk Grid (Figure 1)was used to determine the % of predictions from each recruit in (i) accurate, (ii) under-perception and (iii) over-perception zones as a measure of the perception of respiratory compromise 2. Adherence to ICS inhalers during study period was monitored using doser-devices (95/192; -10) 3. Use of quick-relief metered dose inhaler wasmonitored during study period using doser-devices (181/192; -16)

  13. Figure 2 Participant enrolment in the peak expiratory flow (PEF) feedback and no feedback conditions

  14. A/ Are the results of the study valid? – Screening Questions

  15. A/ Are the results of the study valid? - Screening Questions

  16. A/ Are the results of the study valid - Detailed Questions

  17. B/ What are the results?

  18. C/ Will the results help me locally?

  19. Summary and Conclusions The study supports the suggestion that predicting peak flow values followed by feedback does improve the perception of lung function in children with asthma from a specified ethnic group in USA. However there are flaws in the methodology and results are not clear compromising validity of paper and results Not sure that it could be applied to local population - ideally need to look at local population to determine similar effect.

  20. Bottom Line An interesting concept which has potential to improve perception of lung function but needs further research to determine whether applicable to local population and whether there are benefits on the control of symptoms.

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