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Asthma control is a measure of the reduction in symptoms, prevention of exacerbations, and maintenance of good lung function. Current guidelines state that well controlled asthma requires no symptoms, no exacerbations, and normal lung function.1

Health professionals should tailor asthma review to allow for patient preference (including frequency of professional review), as well as asthma severity, risk of severe attacks, and the type of maintenance treatment plan in place.2
Free Peak Flow Chart from London Allergy and Immunology Centre 

 Free on-line peak flow diary from  www.peak-flow-diary.co.uk   
                           

Is the new EU-scale meter the same as the ATS-scale meter?
No.  Whilst the scale may look similar, only meters that display the text 'EN 13826' have been tested to the new standard.  The EN13826 standard includes two important 'airflow waveforms' that are not part of the ATS test procedure for peak flow meters. Some ATS-scale meters have already been shown as failing the new EN 13826 standard .



Asthma severity is based on clinical features, as defined in the following table: 

ClassificationDay-time symptomsNight-time symptomsPEFR*PEFR variability**
Intermittent1 time per week or lessTwice per month or less=/>80%<20%
Mild persistent1 time per week or more but less than once per dayTwice per month or more=/>80%=20-30%
Moderate persistentDailyOnce a week or more=60-80%30%
Severe persistentDailyFrequent=/<60%30%

*PEFR = peak expiratory flow rate as a percentage of expected PEFR according to patient age and height
**PEFR variability = the difference between morning and evening flow rates


Check your spirometry predicted values, record peak flow results in our chart 

The Global Asthma Report 2011 http://www.globalasthmareport.org

Asthma affects 235 million people today and prevalence is rising. Low- and middle-income countries suffer the most severe cases.

We have the tools to counter the devastating personal and economic impact of untreated and poorly managed asthma. 

The British Asthma Guideline recommends the Royal College of Physicians three questions to assess asthma control over the preceding month.

Have you had any difficulty sleeping because of asthma symptoms, have you had your usual asthma symptoms during the day, and has your asthma interfered with your usual activities?

A personal asthma action plan is a tailored written record of what action to take when symptoms or peak flow readings deteriorate. It includes information about when the patient needs to seek medical help or emergency care. This encourages the patient to take more responsibility for their asthma management.3 Patients should be given autonomy to step up and step down their treatment as detailed in their asthma action plan, in response to their symptoms or peak flow monitoring

Additional resources

Asthma UK

http://www.asthma.org.uk/index.html

BTS SIGN Guidelines

http://www.sign.ac.uk/guidelines/fulltext/101/index.html

GINA

http://www.ginasthma.com/

Asthma review and action plan guidelines

http://www.pcrs-uk.org/resources/asthma_guidelines.php

  1. National Asthma Panel. Data from Health Survey for England 2001, Joint Health Surveys Unit, 2003, The Scottish Health Survey 1998, Joint Health Surveys Unit, 2000, Census 2001 (Office for National Statistics). Asthma UK 2006.
  2. Powell H, Gibson PG. Options for self management education for adults with asthma. Cochrane Database of Systematic Reviews, 2002, Issue 3. Art No: CD004107.
  3. McArthur R, Stephenson P (Eds). Personal Asthma Action Plans. 2008: GPIAG Opinion No 12.
  4. Pearson MG, Bucknall CE, editors. Measuring clinical outcome in asthma: a patient-focused approach. London: Royal College of Physicians; 1999
  5. Pinnock H, Levy M (Eds). Asthma Review 2008: GPIAG Opinion No 23.
  6. Pinnock H, Fletcher M, Holmes S, et al. Setting the Standard for routine asthma consultations: a discussion of the aims, process and outcomes of reviewing people with asthma in primary care. Primary Care Respiratory Journal 2010;19(1):75-83.

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