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Teaching Tips for Using the Asthma Peak Flow Diary

by Thomas F. Plaut, M.D.

These tips can help you teach parents to use an asthma peak flow diary effectively. If time is limited, explain only a single category (medicines, signs and symptoms or comments) and continue instruction at the next visit. We send the diary out to patients before their first asthma consultation. We find that most of them can understand the written instructions and can fill out much of the diary without difficulty. We review and analyze their record with them at the first visit.

Triggers, Comments
  • Ask patients to look for triggers when their peak flow drops.
  • Talk about the effect of triggers (such as cold air, cigarette smoke, cats, exercise) on peak flow rate.
  • Compare the effect of an upper respiratory infection on peak flow and symptoms before and after an effective preventive treatment plan is in place.
  • Illustrate ways the patient can avoid triggers, pre-treat before encountering anticipated triggers, and/or use medicine to eliminate symptoms caused by triggers.
  • Suggest that the patient record possible triggers, visits to the doctor and other significant events.
Peak Flow Rate
  • Show that peak flow often falls before signs of asthma appear and return to normal after they disappear.
  • Encourage patients to predict their peak flow scores to improve their perception of changes in air flow.
Medicine
  • Record the brand name, dose and frequency of each medication in the first column. Ask the patient to record each dose.
  • Calculate and record the discard date for each inhaler.
  • Tell the patient that inhaled steroids usually take one to four weeks to produce the full preventative effect. An inhaled beta-agonist usually increases peak flow within one to ten minutes.
Signs
  • Encourage patients to use the signs score in addition to peak flow when they communicate with the office by telephone.
Record keeping
  • Suggest that your patients record data each morning, half an hour after rising.
  • Once the patient understands asthma triggers, asthma medicines, and has been in the green zone for at least one month, it is safe to reduce the frequency of recording.
  • Some patients find they need to make entries in the diary only when signs of asthma are present, they enter a threatening environment or they change their medication.

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