When you visit your doctor or nurse, they will want to know how well you are not only that day but in the run-up to the visit. The more information they have, the easier it is to give you the best care and treatment. In this example we will demonstrate how using the Asthma Assistant can help your doctor or nurse assess you and your needs.

Case Study

Name: Alice
Age: 13 years

Background
Alice has had asthma for 6 years. Lately, she has not been doing so well with her schoolwork. Her teachers say she seems tired in class all the time. When the doctor examines her she seems well. Her peak flow today is 360 l/min. She has a peak flow meter at home but does not always use it. Her best value (she thinks) is about 370 l/min. The doctor checks her inhaler technique, which is very good. Alice says she feels fine and her asthma is not troubling her. She does sometimes find her symptoms come on after cross-country running at school, which she does Tuesdays and Thursdays. She sometimes coughs at night but can’t remember how often. She takes two puffs of her becotide .preventer morning and evening each day, and her blue reliever when she needs it. Alice’s doctor suggests that she monitors her asthma for two weeks then returns to see him.

Monitoring with the Asthma Assistant
Alice monitors her asthma using the 'Basic Daily Card'. After two weeks she prints out the 'Basic Daily Report' and takes it to her doctor. A section of this report representing 10 days of data entry is shown below.

 
Alice’s personal best peak flow is higher than she thought: it is 400l/min (shown in brackets below Green Zone on the bar chart). Alice’s peak flow readings are frequently out of her green zone. You can see from the bar chart that her green zone is 100% to 80% of her personal best peak flow. Her peak flow readings are close to her red zone (50% or less of personal best peak flow) on several days when they are only 60% of her personal best peak flow. In addition, her diurnal variation is near to or greater than 20% on 8 out of 10 days shown. The low peak flow readings and diurnal variation of 20% or more indicate that her asthma is out of control.

On the days she goes cross-country running (Tuesdays and Thursdays) she has symptoms in the day and night and needs to use her reliever. This indicates that running is triggering her asthma. Despite her variable peak flow, Alice does not note symptoms on other days or nights or the need to use her reliever. She has entered that she uses 4 puffs of her preventer daily, so she is taking her medication regularly. She also rates her asthma as 'Good' every day; this implies she feels fine and does not think her asthma is causing her any problems.

Alice’s 'Morning Peak Flow Overview' which appears at the bottom of the 'Monthly Basic Report' is shown below. It highlights the fact that her average peak morning peak flow is only 269 l/min, equal to 67% of her personal best peak flow. Her lowest morning peak flow is only 240 l/min, equal to 60% of her personal best peak flow.

 

Summary
This report makes it much easier for Alice's doctor to assess how well she is. It illustrates that her asthma is very badly controlled. Even though she says she is fine, she is definitely at risk of a bad attack. Her peak flow is very variable, with a big diurnal variation and some particularly low readings at 60% of her personal best. The information from this report will help Alice's doctor give her the most appropriate advice and treatment. It also provides an excellent focal point for discussion and education between Alice and her doctor.