PEAK FLOW MONITORING IN OLDER ADULTS WITH ASTHMA

We propose a five-year Demonstration and Education project to assess the
incremental value of peak flow monitoring (PFM) over symptom monitoring
(SM) as a management tool for asthma control in adults greater than or
equal to 50 years with moderate-severe asthma. We will develop three
parallel asthma education programs for older adults using as our base an
existing asthma education program (AIR/Kaiser Adult Education Program)
of demonstrated efficacy for adults ,50 years of age. All three programs
will incorporate the same educational and behavioral techniques and
include symptom monitoring. Two of the programs will also incorporate
PFM, one on a regular (twice daily) basis, and one on an "as needed"
basis. For these latter two programs, peak flow measurements will be
used as the basis for monitoring asthma control; for the third, symptoms
alone will be used to monitor asthma control. The project will have two
phases. In Phase 1, the AIR/Kaiser program will be adapted to be
appropriate for an older age group and to incorporate he two strategies
for PFM. The three interventions will then be tested in small groups of
patients greater than or equal to 50 years with moderate-severe asthma
(total N=60). We will also do a substudy of peak flow compliance in a
group of 30 subjects, In Phase 2, 268 patients with moderate-severe
asthma will be randomized on a 1/2:1/1:1 basis into the three
intervention programs (three weekly sessions of 90 minutes each), which
will run concurrently. Each arm will have approximately equal
representation from both genders and two age groups (50-64, >65 years).
Follow-up involve phone contacts every three months and in-clinic visits
every six months for two years. Primary outcome variables will be health
care utilization and asthma-specific quality of life. Secondary outcomes
will be average lung function, measured by one-second forced expiratory
volume, over the follow-up period, and diurnal variation in peak flow.
The PFM programs, when compared to the SM program, will test the
incremental effectiveness of PFM when initiated with appropriate,
fundamental instruction in asthma managements.