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Thursday, January 17, 2008

Peak flow meter compliance in question

I always forget to do peak flows when I 'm working in the emergency room. In fact, I've been cornered by my boss more times regarding this than anything else. I admit I should remember to do them, but I still continue to forget.

We used to have to do peak flows on all patients, but one of my co-workers complained that we were wasting our money doing peak flows on patients other than asthmatics. And this might be part of my problem, as if I did them on everyone I'd never forget.

Still, occasionally, we have a new doctor order a peak flow on a COPD patient, but it is my experience that the peak flow number on about 90% of them goes down after the treatment as opposed to up. And then the doctor thinks he has to admit the patient based on the peak flow alone.

In fact, while the American Lung Association states they may be used for COPD, some lung organizations, like the National Lung Health Education Program, note point blank, "This device SHOULD NOT be used to diagnose or monitor COPD."

I don't know how credible that second website there is, but I agree with it.

The idea of using the peak flow meter is something that has been taught to child asthmatics for about 30 years now. From all my hospital visits when I was a kid, I have probably 30 of them crammed into a bag in my basement. Some might even be antiques by now.

The general idea behind peak flows is that the child will use it as a guide or "tool", according to NationalJewish.com, which has a great tutorial on using peak flows.

"Your peak flow meter is only an aide," the site states, "to you. Do not rely on your peak flow numbers alone when deciding whether to take your rescue medicine or call your doctor. Your symptoms also need to be considered."

The general idea is that they go home, blow in the meter morning and night for two weeks to obtain a normal value or "personal best". After that, they are taught to blow in the meter once a day, or if they are feeling asthma symptoms.

If the peak flow number is 80% of the patient's "personal best," the child is expected to use his rescue inhaler. And, after 20 minutes, if the peak flow is not back to normal then the patient is expected to call his or her doctor.

If the inhaler doesn't work, the patient is supposed to go see his or her doctor. If the number is 60% of normal, the patient is supposed to consider this an emergency, take the rescue medicine, and go the the doctor or emergency room.

The problem I see as an RT is this: very few asthmatics are compliant with their peak flow meters. In the past year, I remember one patient who used her meter on a regular basis, and knew what her normal value was. But she was an adult, and didn't need the peak flow to know she needed to be in the emergency room.

As far as I an remember, that was the only compliant patient I've ever had here.

When I was a kid I never used my meter. When I was breathing good I had better things to think about than blowing into that darn thing, and I suspect most kids are the same way. However, it probably would have been a good idea had I done so, may have even saved me some stress.

I did find one study about compliance, and it showed that about 80% of asthmatics were indeed noncompliance, however the study must have been inconclusive, as it called for more studies on the matter. I think that would be a good study.

So, while the peak flow meter is an effective tool for asthmatics, especially asthmatic children, I will continue to question patient compliance with the device.

5 comments:

Glenna said...

Hmmmm....you reminded me of a story I should tell on myself...I'll go blog that. :-)

Amy said...

My daughter's compliant but only b/c I force her. :) I'm hoping that by the time she's a teenager and doesn't listen to me anymore, maybe using the thing will be habit and she'll do it, anyway.

Djanvk said...

I agree with you, I have a habit of forgetting to do one on COPD patients also, I have also read it is not a good measure on how they are doing, but it does work well for asthmatic.

I was cornered by a Doc one night, she was mad I didn't do one on a COPD patients. I gave her my talk and now I don't think she likes me...oh well.

Anonymous said...

At what age should a kid start doing these? When pneumonia-boy was in the hospital, I was told he was probably too young (3.5). When should I start asking for these for him?
-lpnmon

Freadom said...

According to NationalJewish.com, which I think is a very respectable organization for the research and study of asthma, any child over the age of 5 who has asthma should use a peak flow meter.

You can check out the link above, I fixed it.