USE OF PEAK FLOW METER AS AN OBSERVATION AND TEACHING TOOL IN AN EDUCATIONAL PROGRAM IN WOMEN WITH ASTHMA Noreen M. Clark, Molly Z. Gong, Martha B. DeRoeck, Jane E. Burton, Jimmy J. Yu, Melissa A. Valerio, Xihong Lin, William F. Bria, Timothy Johnson University of Michigan, USA May 2001 Supported by NHLBI Lung Division Grant HL60884

BACKGROUND As indicated in the Expert Panel Report on Guidelines for the Diagnosis and Management of Asthma (1997), peak flow monitoring (PFM) is helpful in managing patients with moderate to severe persistent asthma. However, several studies have illustrated that patients often fail to use PFM or are very inconsistent with its use (Clark et al, 1992).

PURPOSE A component of a study for evaluating an innovative telephone counseling program for women with asthma, encourages women to use PFM and a diary as self-observation tools for one month. The purpose of this component is to examine the use of PFM as a teaching tool in the self-regulation learning process.

AIMS 1. To describe the PFM component in the “Women Breathe Free” telephone counseling and education program for women with asthma. 2. To examine the association between use of PFM, demographics, and disease severity in women with asthma at baseline.

METHODS Data Collection To date, 100 women aged 18 years or older with a physician diagnosis of asthma have been recruited from the University of Michigan Asthma & Airway Clinic. Baseline data have been collected by telephone interview.

SAMPLE

Ethnicity & Age

Annual Household Income & Education < High School Grad 2%

Marital & Working Status Widowed 3% Divorced 10% Single 14% At Home 21% Full Time 52% Part Time 27% Married 73%

Medical Insurance 2% 98%

RANDOMIZATION Subsequent to baseline data collection, the participants were randomly assigned into either intervention or control group. Women in the intervention group have received the “Women Breathe Free” telephone counseling program. Women in the control “usual care” group will receive “Women Breathe Free” if the program is shown to be effective.

“Women Breathe Free” Program An educational intervention with multiple components designed for women with asthma Components A. Theoretical framework based on social cognitive theory, particularly the principals of self-regulation B. Program format is six sessions of telephone counseling C. Unique features: a) addresses gender-related asthma management problems; b) peak flow monitoring and diary keeping used as teaching tools for learning self-regulation processes

Peak Flow Monitoring & Diary Component 1. Steps of self-regulation learning process: a. Selecting a problem b. Observing and researching the asthma management routine c. Identifying a self-management goal d. Developing a plan to reach goal e. Establishing a reward when the goal has been achieved 2. “Women Breathe Free” participants received asthma learning kit containing a workbook, a list of gender-related concerns for women, and specially designed diaries.

Peak Flow Monitoring & Diary Component 3. Participants also received a peak flow meter (AsthmaMentor™, Respironics HealthScan Allergy and Asthma Products, Inc., Cedar Grove, NJ) with an instructional video tape — “Managing Your Asthma: A Game Plan for Success” — to ensure that all program participants are using the same meter.

During the self-observation step of counseling, the health educator: a. Coaches the participant on how to correctly use a peak flow meter. b. Asks the participant to record her PFR in her asthma diary twice daily in the morning and at evening for one month. c. Identifies the participant’s personal best number and calculates peak flow zones during a phone counseling session based on 2-4 weeks of PFM.

During the self-observation step of counseling, the health educator: d. Encourages participants to mail copies of their asthma diaries including peak flow data, to be used during telephone counseling. e. Helps participants see potential connections and patterns of association among peak flow measurements and other diary dimensions including symptoms, medication use, triggers, gender-specific issues and daily activities.

DATA ANALYSIS & FINDINGS

Multi-level logistic regression test for odds ratio were conducted using a dichotomized (use peak flow meter versus no use of peak flow meter) variable.

CONCLUSIONS Nearly 50% of participating women use PFM Women who use PFM have better asthma self-management Women who use PFM have better Quality of Life Women who use PFM report more doctor office visits