PEFR
meter has been around for over half a century and has found wide acceptance
throughout the western world as a home monitoring tool for asthma management.
Current International Gidelines on Asthma Management rely very much
on a patient regularly using a PEFR Meter at home for monitoring asthma,
recording the readings and seeking medical guidance on the treatment
as advised.
Its importance can be judged from the fact that the National Health
Scheme (UK) and Mediclaim Scheme (USA) subsidize its purchase at huge
cost.
It is understood that in UK alone, a country with population of only
52 million (approx. 5% of India), over 340,000 PEFR meters are sold
annually to patients through the NHS alone. It is estimated that there
are around 5 million PEFR meters in use in UK. In USA with a population
of 285 million, 1,900,000 meters are sold annually. The annual sale
of PEFR meters to patients in India could be around 3000 to 4000 units
or so.
The experience in UK has shown that the emergency admissions of asthmatics
to hospital has reduced to a considerable extent, thus releasing the
beds for other patients and saving the NHS hundreds of thousand of pounds
in the process.
The figures cited above for huge sale of PEFR Meters in UK and USA goes
to show the importance these countries and their medical authorities
attach to home monitoring of PEFR in asthma management.
PEFR Meters have been around in India for last several years. However
its use in doctor’s clinics or at home is very negligible, in
spite of the fact that treating asthma purely on clinical examination
and patient’s feedback offer a very subjective mode of treatment.
It is not unusual for patients with asthma to feel fine and not notice
changes in their breathing even when the airways may have become significantly
narrower. Treating asthma without regular monitoring of patient’s
PEFR is like treating blood pressure without use of a sphygmomanometer.
One does hear occasionally of physicians judging the condition of the
airways on the basis of blowing of candles. In all fairness one has
to concede that this was a useful tool in the era before the invention
of the PEFR meter but not today. Today in the era of MRI, CT Scan, ultrasound
imaging, pulmonary function test spirometry, etc., one needs more precise
indicator which can give objective information so as to effectively
treat asthma.
No doubt, a few selected patients are subjected to pulmonary function
test. Such a test will show the status of PEFR at a particular time
however the PEFR levels continually change on account of several factors
including medication. Therefore unless the patient is regularly monitored
for the PEFR and its changes studied, how will the patient be treated
effectively?
Very importantly, when a patient is encouraged or coaxed into using
a PEFR meter regularly and keeping daily records, the attending physician
gets considerable help in deciding the line of treatment very objectively
then treating a patient only the basis of subjective feedback or clinical
examination alone. There is no doubt that treatment based on objective
information will yield much better asthma management.
In spite of all the advantages of home monitoring of asthma with a PEFR
meter, why the apathy in its use? Why the infinitesimal use of PEFR
meters in the country with over 50 million asthmatics? Is it the price
of the PEFR meter alone?
At one time a PEFR meter used to cost around Rs.1000/- which no doubt
was a deterrent in its acceptance by the patients but now the prices
have been halved. A price now of Rs.500/- of a PEFR meter cannot be
said to be unaffordable, at least to the burgeoning middle class of
the country, compared to the loss of earnings, missed schools or colleges
with unmonitored asthma.
Can it be that the physicians are not too keen to recommend the home
monitoring, as they are afraid that their patients will bother them
with frequent reporting of the readings and disturbing them too often?
This was the experience abroad initially.
On investigating, it was found that attending physicians did not spend
sufficient time properly explaining the PEFR meter’s use, interpretation
of the readings, when to report etc. If time is taken out by the physician
to do this, then home monitoring of PEFR will be a boon, both to the
patient as also the physician. Management of asthma has to be a partnership
between the patient and the physician.
As a matter of fact, the present day meters are provided with coloured
zones, green zone indicate safe zone, yellow zone indicate caution zone
with reporting to the physician and red zone calls for an immediate
medical intervention in consultation with the physician, brooking no
delay. Thus regular monitoring with a PEFR meter makes asthma management,
easier both for the patient and the physician.
Nomograms are also available which indicate normal values of PEFR for
males, females and children, which assists a family physician to guide
the patient into the proper interpretation of the zones.
Not much importance is given to the fact that unmonitored asthma could
result in emergency visits, injections, nebulizations or a life threatening
situation needing immediate hospitalization with huge cost, loss of
income, missed classes in schools or colleges, and on a wider scale
even the loss of income, missed classes in schools or colleges, and
on a wider scale even the loss of enormous man hours. All this can be
avoided or at least minimized when home monitoring of asthma is done,
not only done but done in very regular way and readings recorded so
as to help in their interpretation and take the necessary steps to avoid
emergencies.
Inquiry with physicians reveal that some of them do recommend to their
patients to buy a PEFR meter and use it; however most of the patients
do not follow the advise. It has been observed that just prescribing
a PEFR meter does not cut much ice with the patient. Majority of them
avoid buying one.
The attending physician has to sell the idea of the many merits of investing
in a PEFR Meter. Also cautioning that not having one could result in
emergency situations like hospitalization resulting in considerable
financial loss or absenteeism from work, schools etc. or spending on
emergency treatments. The cost of this to the patient will be many times
more than the cost of a PEFR meter.
Only if the attending physician is convinced of the importance of home
monitoring and the benefits ensuing from thereof, then surely, it will
not be difficult at all for the physician to convince the patient of
the definite need of home monitoring of asthma using a PEFR meter.
It is fervently hoped that time will soon come when the need of home
monitoring of asthma will be well understood by a large body of Indian
physicians and who in turn will recommend their use to the patients.
This will considerably boost effective management of asthma in the country.
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