Objective measurements of compliance in asthma treatment.

BACKGROUND: Self-management protocols and home peak expiratory flow rate monitoring are thought to improve asthma care.
OBJECTIVE: Compliance and accuracy of patients' record keeping were measured during a guided self-management protocol. Video, face-to-face instruction, and written protocols were part of the educational program.
METHODS: Twenty patients participated in a 5-week study using memory capable peak expiratory flow rate meters and inhalers. During the baseline week all patients followed their customary approach to treatment and kept written diaries of peak expiratory flow rate and inhaler usage results; thereafter, they followed an individually designed self-management protocol.
RESULTS: Good technique and knowledge were found during the baseline visit and improved by the last visit. Compliance with the protocol during the fifth week occurred in 40% of patients with underusage of inhalers in 50% and overusage in 10% despite allowing for a 10% inaccuracy in recording. Patients keeping inaccurate records early in care tend not to improve. Errors in recording inhaler usage increased from 47% to 58% of days during the final week. Patients inflated peak expiratory flow rate scores (P < .01) over time. Slight improvement in the peak expiratory flow rate was found for the entire group (baseline week 371 L/min versus final week 386 L/min P < .05).
CONCLUSIONS: Despite an extensive educational program in the self-management of asthma, compliance with recommended treatment was only 40%. Electronic monitoring of peak expiratory flow rate and inhaler usage can provide early identification of patients who do not comply.