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In reply
We agree with Dr Weinberger that symptom monitoring is an important component of patient self-assessment. Our article did not state or imply that self-monitoring by using a peak flow meter is superior to other forms of monitoring. Rather, we recognize it as one of several ways in which an older asthmatic child may assess the severity of an asthma exacerbation. As we reported in our article, the National Heart, Lung, and Blood Institute encourages patients to establish their personal best peak expiratory flow (PEF) and use it as the basis of their asthma action plan, stating that "short-term daily peak flow monitoring is helpful for assessing the severity of a patient's asthma."1
Most of the studies assessing the utility of peak flow monitoring have been performed in adults. In one trial, patients asked to monitor PEF twice per day had lower symptom scores and less use of maintenance therapy compared with a control group.2 Ignaio-Garcia and Gonzalez-Santos3 compared patients who used PEF readings as the basis for intensifying asthma therapy with those who used symptom monitoring. After 6 months, patients in the experimental group had significant improvements in days lost from work, number of exacerbations, days receiving antibiotic therapy, nocturnal awakening, emergency visits, and admissions, while the control group exhibited more modest benefits. Similarly, Lahdensuo et al4 reported that patients who were allowed to adjust their medications based on daily PEF readings had fewer unscheduled medical visits, fewer missed days of work, and higher quality-of-life scores compared with those without peak flow meters who could not make medication changes on their own.
Although more data in children are needed, we believe that clinicians should prescribe peak flow meters and teach their proper use, and we recommend them as an important component of a self-management plan. We stand by our article's conclusion that the underprescribing of peak flow meters, their underutilization, and a lack of knowledge regarding score interpretation limits their potential efficacy in asthma self-management.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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