Self-Monitoring

Asthma Self-Monitoring

Establish the patient’s preference to use symptoms or peak expiratory flow to monitor severe asthma.

• Explain to the patient that keeping track of the types and timing of severe asthma symptoms is helpful because it makes it easier to spot when things are not going well. An increase in symptoms can be an early warning sign that action is required. It also shows them when things are going well.
• Tracking the days when patients have fewer or no symptoms can help build their confidence in managing severe asthma.
• Patients can use a notebook/ diary to write symptoms or may choose to use phone apps, desktop spreadsheets. It is important to discuss options to find what works best for each individual.
• Phone apps (e.g. “Asthma Buddy” and “KissMyAsthma” are available free of charge) have basic symptom diaries built-in.
• Patients should bring their symptom records to every appointment to help communicate their recent symptoms and worsening with their health professionals.
• Help patients understand when they should commence or resume their maximum dose of corticosteroids, based on worsening symptoms and the speed at which they normally deteriorate.
• Discuss with the patient (and family) how to identify worsening symptoms or a failure to respond to increased treatment that require a visit to hospital or ambulance. Discuss the importance of calling an ambulance if required, as some patients may feel guilty about doing so.

• Peak expiratory flow (PEF) monitoring is useful for patients who prefer PEF to symptom monitoring and those who have been advised to do PEF by their respiratory physician.
• Individuals with low symptom and bronchoconstriction perception can also use PEF monitoring.
• Manual or electronic peak flow meter may be used.
• Patients should use either NAC Woolcock Peak Flow Chart or another compressed chart as these help patients identify flare ups more easily  (Jansen et al. 2012)
• Peak flow monitoring is usually commenced over a minimum of 8 weeks of twice daily monitoring. A good time to start is when the patient first presents to the severe asthma clinic.
• Patients should bring their PEF recordings to every asthma review.
• After 8 weeks of PEF monitoring , review the PEF Chart with the patient.
• In collaboration with the patient, use their results and patterns of deterioration to identify and agree on set points to commence or return to maximum corticosteroids and when to go to hospital on their AAP.
• Reviewing past exacerbations on patients PEF chart can be used to identify action points for written Asthma Action Plans (see image below).

An example of an asthma flare-up on a compressed PEF chart.