Use of peak flow meter as an observation and teaching tool

USE OF PEAK FLOW METER AS AN OBSERVATION AND TEACHING TOOL

IN AN EDUCATIONAL PROGRAM IN WOMEN WITH ASTHMA

Noreen M. Clark, Molly Z. Gong, Martha B. DeRoeck, Jane E. Burton, Jimmy J. Yu, Melissa A. Valerio, Xihong Lin, William F. Bria,

Timothy Johnson

University of Michigan, USA

May 2001

Supported by NHLBI Lung Division Grant HL60884

BACKGROUND

As indicated in the Expert Panel Report on Guidelines for the Diagnosis and Management of Asthma (1997), peak flow monitoring (PFM) is helpful in managing patients with moderate to severe persistent asthma. However, several studies have illustrated that patients often fail to use PFM or are very inconsistent with its use (Clark et al, 1992).

PURPOSE

A component of a study for evaluating an innovative telephone counseling program for women with asthma, encourages women to use PFM and a diary as self-observation tools for one month.

The purpose of this component is to examine the use of PFM as a teaching tool in the self-regulation learning process.

AIMS

1. To describe the PFM component in the “Women Breathe Free” telephone counseling and education program for women with asthma.

2. To examine the association between use of PFM, demographics, and disease severity in women with asthma at baseline.

METHODS

Data Collection

To date, 100 women aged 18 years or older with a physician diagnosis of asthma have been recruited from the University of Michigan Asthma & Airway Clinic. Baseline data have been collected by telephone interview.

SAMPLE

African-American

6%

Other5%

White89%

Ethnicity & Age

41 - 50 years26%

61 - 70 years13% 31 - 40

years23%

51 - 60 years30%

< 20 Years1%

> 70 years1%

20 - 30 years6%

Annual Household Income & Education

< 20 K10%

60 - 80 K17%

80 - 100 K13%

> 100 K21%

20 - 40 K20%

40 - 60 K19%

< 20 K10%

60 - 80 K17%

80 - 100 K13%

> 100 K21%

20 - 40 K20%

40 - 60 K19%

4 Years College34%

Post Grad17%

High SchoolGrad 29%

2 Years College18%

4 Years College34%

Post Grad17%

High SchoolGrad 29%

2 Years College18%

< High School Grad 2%

At Home 21%

Full Time 52%

Part Time 27%

Marital & Working Status

Divorced 10% Single 14%

Widowed 3%

Married 73%

Medical Insurance

Yes

No

Yes

No98%

2%

RANDOMIZATION

Subsequent to baseline data collection, the participants were randomly assigned into either intervention or control group. Women in the intervention group have received the “Women Breathe Free” telephone counseling program.

Women in the control “usual care” group will receive “Women Breathe Free” if the program is shown to be effective.

“Women Breathe Free” Program

An educational intervention with multiple components designed for women with asthma

Components

A. Theoretical framework based on social cognitive theory, particularly the principals of self-regulation

B. Program format is six sessions of telephone counselingC. Unique features:

a) addresses gender-related asthma management problems;b) peak flow monitoring and diary keeping used as teaching

tools for learning self-regulation processes

Peak Flow Monitoring & Diary Component

1. Steps of self-regulation learning process:

a. Selecting a problem

b. Observing and researching the asthma management

routine

c. Identifying a self-management goal

d. Developing a plan to reach goal

e. Establishing a reward when the goal has been

achieved

2. “Women Breathe Free” participants received asthma learning kit containing a workbook, a list of gender-related concerns for women, and specially designed diaries.

Peak Flow Monitoring & Diary Component

3. Participants also received a peak flow meter

(AsthmaMentor™, Respironics HealthScan Allergy

and Asthma Products, Inc., Cedar Grove, NJ) with an

instructional video tape — “Managing Your Asthma:

A Game Plan for Success” — to ensure that all

program participants are using the same meter.

Example – My Asthma Diary

My Name: Jane Doe My Birthday: / / My personal best peak flow reading (PBR) is: Green Zone: no symptoms or above 80% PBR Yellow Zone: some symptoms or 50-80% PBR Red Zone: severe symptoms or below 50%PBR

Day & Date Mon

a.m. 1/8/01 p.m.

Tue

a.m. 1/9/01 p.m.

Wed

a.m. 1/10/01 p.m.

Thur

a.m. 1/11/01 p.m.

Fri

a.m. 1/12/01 p.m.

Sat

a.m. 1/13/01 p.m.

Sun

a.m. 1/14/01 p.m.

Peak flow rates 300 310 260 300 230 220 220 240 250 270 260 250 220 280

Nosymptoms

Somesymptoms

Severesymptoms

Menstrual bleeding Oral contraceptivesEstrogen R T (ERT)

SymptomsRunny nose,scratchy throat,heartburn.

Same as yesterdayplus headache. Noheartburn.

Cough, slight chesttightness, throatclearing, yellowmucus from nose,headache, cramps.

Nasal and chestcongestion,wheezing, woke upcoughing in night,breathless, cramps.

Tired, restless,heartburn, cough,wheeze, stuffynose, thick yellowgreen mucus.

Cough, urinaryleakage, chest tight,sinus drainage,headache.

Same as yesterdaybut no headache.

Medicine

Serevent 4puffs/dayFlovent 4puffs/daySingulair 10mg/dayClaritin 10mg/dayPrilosec 20mg/day

Same as Mon plus2 Advil 3 timestoday.

Same as yesterdaybut doubledFlovent. Used 2puffs albuterol 3times today.

Same as yesterday.Switched fromalbuterol puffer tonebulizer; 4treatments.

Same as yesterday.Called Dr., put onZithromax for sinusinfection. NoAdvil.

Same as yesterday.Day 2 of Z-Pak.

Same as yesterday.Day 3 of Z-Pak.

PossibleTriggers

Allergies? Cold?Drank 3 cups ofcoffee and ate spicyfood for dinner.

Time in dampmoldy basement,used Lysol &Tilex.Getting a cold?Period due...

Definite coldsymptoms.Premenstrual. Timein dusty storeroomat work. Feelingmoody & anxious.

Period started. Coldworse. Changedtoner in printer atwork. Cooked andbaked in hotkitchen.

Sinus infection.Stressed, tired. Hadto clean house-- in-laws coming.

Cold, laundry soap,taking the basementstairs a lot. Father-in-law smoking inhouse, mother-in-law’s perfume.

Cold/sinussymptoms, stress,fatigue.

Activities andEvents

Took kids to school& back, worked,cooked, ranerrands, exercised.

Same as yesterdayplus laundry, sweptbasement, cleanedbird cage, walkeddogs.

Kids, work, petcare, cooking,stayed up later thanusual.

Preparing forfamily dinner onSat. Usual tasks athome and work--noexercise

Stayed home fromwork-tried to restbut had to cleanand cook. Napped.

Stripped the beds,did the wash.Hosted dinner forin-laws.

Watched T.V.Rested on thecouch, napped.

During the self-observation step of counseling, the health educator:

a. Coaches the participant on how to correctly use a peak flow meter.

b. Asks the participant to record her PFR in her asthma diary twice daily in the morning and at evening for one month.

c. Identifies the participant’s personal best number and calculates peak flow zones during a phone counseling session based on 2-4 weeks of PFM.

d. Encourages participants to mail copies of their asthma diaries including peak flow data, to be used during telephone counseling.

e. Helps participants see potential connections and patterns of association among peak flow measurements and other diary dimensions including symptoms, medication use, triggers, gender-specific issues and daily activities.

During the self-observation step of counseling, the health educator:

DATA ANALYSIS & FINDINGS

Once a day every day2 %

AM & PM every day

6 %

Never use1 4 %

Used it in the past - any more

1 5 %

Use very rarely2 4 %

Only w hen ashtma attack is

coming on3 0 %

2 - 3 times a w eek every w eek

9 %

Multi-level logistic regression test for odds ratio

were conducted using a dichotomized (use peak

flow meter versus no use of peak flow meter)

variable.

Measure N OR p- value

Quali ty of Li fe 96 1.0658 0.0014

Doctor visi ts 96 1.4162 0.0010

Self- management 96 1.0457 0.0001

Ethnici ty 96 1.0146 0.0480

CONCLUSIONS

• Nearly 50% of participating women use PFM

• Women who use PFM have better asthma self-management

• Women who use PFM have better Quality of Life

• Women who use PFM report more doctor office visits