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View instructions for using the Asthma Peak Flow Diary
Twenty
years ago, almost all of the patients with asthma
in my pediatric practice were having problems
such as coughing at night, wheezing with exercise,
and sudden onset of asthma episodes. Often parents
did not know what was triggering their child’s
asthma problems. They could not remember when
symptoms had started or how they had progressed.
They did not understand the relationship between
the dose of each medicine and its effects, both
good and bad.
When
I saw the parents in my office, I spent the greater
part of each visit trying to identify triggers
and evaluate the effect of treatment on their
child’s symptoms. Parents’ recollections
were often incomplete and imprecise. To improve
their recall, I devised a daily peak flow diary
for parents and teenagers to use. Although I developed
the diary for pediatric patients, it is equally
useful for adult asthma patients.
Teenagers,
parents and adult patients collect data for a
week or more prior to our appointment. This enables
us to spend the visit analyzing what happened,
rather than trying to remember what happened.
As a result, I can make more informed suggestions
for improving their care.
The
patient or parent records the following important
information:
-
fluctuations in peak flow rates (peak flow measures
the patient's ability to exhale quickly)
- all
asthma medicines taken
- suspected
triggers
- asthma
signs and symptoms
Because
the diary clearly demonstrates the relationship
between the various pieces of the asthma puzzle,
it helps parents and patients to accurately recall
events since the last visit. With it they can
clearly and succinctly communicate with me on
the telephone or in the office. It assists me
in gaining the information I need to devise an
effective treatment plan.
The
diary enables patients and parents to head off
and to manage episodes. By checking their peak
flow rate and recording the scores, they can easily
see when they need to adjust their medication
routine. The diary also helps patients and parents
to:
- accurately
recall events since the last visit
- identify
triggers that provoke an episode
- learn
when to start and when to reduce medicines
- remember
to give (or take) medicines regularly
The
peak flow diary portrays four zones of asthma
care. Each is color coded on the traffic light
model, green, yellow or red. Peak flow scores
in the Green Zone (80% to 100% of personal best)
mean that the patient is doing well and can pursue
normal activities. Scores that fall into the High
Yellow Zone (65% to 80% of personal best) indicate
a mild episode. The patient should avoid triggers
and add backup medicines. When scores are stuck
in the Low Yellow Zone (50-65% of the personal
best) oral steroids are needed. When scores are
stuck in the Red Zone (less than 50% of personal
best), the patient is in danger and needs to take
rescue doses of inhaled albuterol and oral prednisone
and then immediately go to the emergency room
or see their doctor.
Patients
and parents who use this diary gain a clear understanding
of their asthma. They begin to notice patterns
in asthma episodes, observe how different medicines
work together and note the effects of changing
a dose or adding or deleting a medicine.
I
ask parents, teenagers and adult patients to keep
a diary each morning while they are learning about
peak flow, the signs and symptoms of asthma, and
the medicines used to treat it. This helps them
accurately assess their progress. They use this
information to make changes in their treatment,
based on the written asthma care plan (the Asthma Action Plan) we have worked out together.
Once
patients achieve excellent control of their asthma,
usually in two months, they gradually decrease
the frequency of diary entries. Some patients
and parents keep a diary only when they or their
child have signs or symptoms, enter a threatening
environment, make a change in medicine routine,
or encounter a trigger. Patients who have had
a serious episode often wish to continue keeping
a daily diary until they are convinced that they will
not again be caught unawares. The diary functions
as an early warning system so they can step up
treatment promptly and avoid asthma episodes. All my
patients keep a diary for the week prior to their
appointment. It is a great aid to communication.
A
peak flow diary is one of the most powerful tools
a patient can use to manage asthma at home.
To
receive a free sheet of the Asthma Peak Flow Diary,
send a self-addressed No. 10 (long) envelope with
postage to:
Sample
Peak Flow Diary
Pedipress, Inc.
125 Red Gate Lane
Amherst, MA 01002
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