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
 Ethnicity & Age
> 70 years
< 20
Years
20 - 30
Other 61 -1%
70 1%
years
5% years
6%31 - 40
African- 13%
American years
6%
23%

White
89%
51 - 60
years 41 - 50
30% years
26%
 Annual Household Income &
Education < High
School Grad
2%
< 20 K
10%
> 100 K Post Grad
21% 17%
20 - 40 K High School
20% Grad 29%
80 - 100 K
13%
4 Years College
40 - 60 K 34% 2 Years College
60 - 80 K 19%
18%
17%
 Marital & Working
Widowe
d 3%
Status
Divorced
10% Single 14% At Home
21%
Full Time
52%
Part
Time
Married
27%
73%
Medical Insurance
2%

Yes

No

98%
 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 counseling
C. 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 Tue Wed Thur Fri Sat Sun
a.m. 1/8/01 p.m. a.m. 1/9/01 p.m. a.m. 1/10/01 p.m. a.m. 1/11/01 p.m. a.m. 1/12/01 p.m. a.m. 1/13/01 p.m. a.m. 1/14/01 p.m.
Peak flow rates 300 310 260 300 230 220 220 240 250 270 260 250 220 280
No
symptoms

Some
symptoms

Severe
symptoms

Menstrual bleeding    
Oral contraceptives
Estrogen R T (ERT)
Runny nose, Same as yesterday Cough , slight chest Nasal and chest Tired, restless, Cough, urinary Same as yesterday
Symptoms scratchy throat, plus headache. No tightness, throat congestion, heartburn, cough, leakage, chest tight, but no headache.
heartburn. heartburn. clearing, yellow wheezing, woke up wheeze, stuffy sinus drainage,
mucus from nose, coughing in night, nose, thick yellow headache.
headache, cramps. breathless, cramps. green mucus.
Serevent 4puffs/day Same as Mon plus Same as yesterday Same as yesterday. Same as yesterday. Same as yesterday. Same as yesterday.
Flovent 4puffs/day 2 Advil 3 times but doubled Switched from Called Dr., put on Day 2 of Z-Pak. Day 3 of Z-Pak.
Medicine Singulair 10mg/day today. Flovent. Used 2 albuterol puffer to Zithromax for sinus
Claritin 10mg/day puffs albuterol 3 nebulizer ; 4 infection. No
Prilosec 20mg/day
times today. treatments. Advil.
Allergies? Cold? Time in damp Definite cold Period started. Cold Sinus infection. Cold, laundry soap, Cold/sinus
Possible Drank 3 cups of moldy basement, symptoms. worse. Changed Stressed, tired. Had taking the basement symptoms, stress,
coffee and ate spicy used Lysol & Tilex. Premenstrual. Time toner in printer at to clean house-- in- stairs a lot. Father- fatigue.
Triggers food for dinner. Getting a cold? in dusty storeroom work. Cooked and laws coming. in-law smoking in
Period due... at work. Feeling baked in hot house, mother-in-
moody & anxious. kitchen. law’s perfume.
Took kids to school Same as yesterday Kids, work, pet Preparing for Stayed home from Stripped the beds, Watched T.V.
Activities and & back, worked, plus laundry, swept care, cooking, family dinner on work-tried to rest did the wash. Rested on the
cooked, ran basement, cleaned stayed up later than Sat. Usual tasks at but had to clean Hosted dinner for couch, napped.
Events errands, exercised. bird cage, walked usual. home and work--no and cook. Napped. in-laws.
dogs. exercise
 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.
 During the self-observation step of
counseling, the health educator:

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.
DATA ANALYSIS &
FINDINGS
 AM & PM
e v e r y da y
6%
O nce a da y e v e r y
da y
2%

2 - 3 tim e s a w e e k
every w eek
N e v e r use 9%
14%

U se d it in the pa st
- a ny m or e
15%

O nly w he n
a shtm a a tta ck is
U se v e r y r a r e ly com ing on
24% 30%
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.
Me a su re N OR p- value

Quality of Life 96 1.0658 0.0014

Doctor visits 96 1.4162 0.0010

Self- m anagem ent 96 1.0457 0.0001

Ethnicity 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