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Using the Asthma Peak Flow Diary

A peak flow diary is one of the most powerful tools a patient can use to manage asthma at home.

This comprehensive three-color diary sheet can help teenagers, parents and adult patients understand asthma and thus manage it more effectively. It gives doctors a wealth of clinical information to use in guiding therapy and assessing progress in patients five years of age and over. The Asthma Signs Diary can be used to assess children less than five years of age.

Twenty years ago, almost all 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, to observe how different medicines work together and to 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. (Click here for a free Asthma Action Plan)

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 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.

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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