Relationship Between Airway Obstruction and Respiratory Symptoms in Adult Asthmatics: Conclusion
As a group, our patients reported improvement in many of their asthma symptoms when seen in follow-up, although PEF values did not change. The reasons for this discrepancy are not clear. It is possible that a daily diary of PEF values would have demonstrated a pattern of improvement not reflective of the single value obtained at the time of the follow-up clinic visit. A placebo effect is also possible in our patients, many of whom had not previously received consistent medical care for their asthma.
Recent studies have demonstrated that practicing physicians frequently do not utilize objective measures of lung function when assessing asthma patients. These studies suggest that a large number of physicians continue to base treatment decisions on patient symptoms alone. In the present study, potentially 48% of the patients initially evaluated would have been treated improperly if assessed solely on the basis of their symptoms (Fig 1). In another study, Emerman and Cydulka have demonstrated that the emergency department therapy of acutely ill asthmatics is altered more than 20% of the time when physicians are made aware of pretreatment levels of airflow obstruction. However, although our data demonstrate the benefit of measuring pulmonary function objectively in asthma management, improvement in outcomes has not been demonstrated consistently in many other studies that have incorporated daily peak flow monitoring as an integral component of asthma care. Thus, the optimal way to incorporate objective measures of pulmonary function into management plans for patients with chronic asthma remains to be defined. Our data suggest that objective monitoring will be most beneficial for those patients who are “poor discriminators’ of their underlying level of airway obstruction. Acute Histoplasmosis