Monitoring
Patients are recommended to self-monitor at home on a daily basis by checking and recording the peak expiratory flow (PEF) using a PEF meter. PEF results should help the patient adjust medication use as instructed by the physician, using an asthma action plan. PEF monitoring becomes life-saving for the group of patients who are unable to sense worsening of their asthma. PEF is not, however, as accurate a measure of pulmonary obstruction as is the forced expiratory volume at 1 second (FEV₁) and the FEV₁/forced vital capacity (FVC) ratio. The frequency of the testing depends on the severity of the patient's symptoms. In mildly symptomatic, well-controlled asthma, the test could be completed once every 1-2 years. In more severe asthma, testing should be done more frequently to determine medication compliance and the patient's ability to monitor and control symptoms.
The Global Policy Steering Group on Improving Asthma Outcomes recommends the following timeframes for monitoring:[96]
A routine review should be scheduled at least annually for all established patients
Patients should be reviewed 3 months after switching or starting treatment
If a patient experiences an exacerbation warranting a visit to the emergency department or hospitalization, an urgent review should be scheduled with their primary care physician within 2-7 working days
How to use a peak flow meter to obtain a peak expiratory flow measurement.
Questionnaires
Several tools are available for assessing asthma symptom control, including simple screening (e.g., GINA's symptom control tool), categorical symptom control (e.g., the UK Royal College of Physicians' 'Three Questions'), and numerical asthma control (e.g., the Asthma Control Test and Asthma Control Questionnaire, 5-item version).[52] GINA's symptom control tool also includes questions that assess risk factors for future exacerbations.[52] However, no questionnaire is ideal in the absence of a comprehensive evaluation. Although the Asthma Control Test shows good internal consistency and content validity, it has shown mixed levels of agreement with clinical measures of asthma and poor cross-cultural validity.[202][203]
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