Control charts demonstrated limited utility for the monitoring of lung function in asthma

Turner, RM; Hayen, A; MacAskill, P; Irwig, L; Reddel, HK

Control charts demonstrated limited utility for the monitoring of lung function in asthma

Turner, RM Hayen, A

MacAskill, P Irwig, L Reddel, HK

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Publication Type:: Journal Article
Citation:: Journal of Clinical Epidemiology, 2012, 65 (1), pp. 53 - 61
Issue Date:: 2012-01-01

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Field	Value	Language
dc.contributor.author	Turner, RM	en_US
dc.contributor.author	Hayen, A https://orcid.org/0000-0003-4046-8030	en_US
dc.contributor.author	MacAskill, P	en_US
dc.contributor.author	Irwig, L	en_US
dc.contributor.author	Reddel, HK	en_US
dc.date.available	2011-04-12	en_US
dc.date.issued	2012-01-01	en_US
dc.identifier.citation	Journal of Clinical Epidemiology, 2012, 65 (1), pp. 53 - 61	en_US
dc.identifier.issn	0895-4356	en_US
dc.identifier.uri	http://hdl.handle.net/10453/115129
dc.description.abstract	Objective: Statistical process control charts have been advocated for use in monitoring of lung function in asthma. We aimed to evaluate their application in asthma using existing data from a randomized trial. Study Design and Setting: Patients on optimal inhaled corticosteroid/bronchodilator therapy (n = 81) were randomized to continue the same or change to corticosteroid alone. Baseline statistical control was assessed from 20 days of electronically recorded lung function (peak expiratory flow [PEF], forced expiratory volume in one second [FEV 1]). The ability to detect lung function changes was assessed during 10 days after randomization. Results: PEF measurements were in statistical control during baseline for only 59-79% of patients for different combinations of five control chart rules (e.g., Rule 1: >3 standard deviations outside mean and 95% expected to be in control), with similar proportions for FEV 1. After randomization, among those previously in statistical control, Rule 1 signaled lower FEV 1 for 35% of patients randomized to treatment change compared with 6% continuing baseline treatment (P = 0.004). Control charts performed poorly for PEF, signaling a decrease for 8% of patients randomized to treatment change compared with 11% continuing treatment (P = 0.7). A paradoxical increase was signaled for many patients continuing treatment. Conclusion: Control charts may not be suitable for use in many patients with asthma. © 2012 Elsevier Inc. All rights reserved.	en_US
dc.relation.ispartof	Journal of Clinical Epidemiology	en_US
dc.relation.isbasedon	10.1016/j.jclinepi.2011.04.012	en_US
dc.subject.classification	Epidemiology	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Asthma	en_US
dc.subject.mesh	Bronchodilator Agents	en_US
dc.subject.mesh	Glucocorticoids	en_US
dc.subject.mesh	Respiratory Function Tests	en_US
dc.subject.mesh	Monitoring, Physiologic	en_US
dc.subject.mesh	Drug Therapy, Combination	en_US
dc.subject.mesh	Software Design	en_US
dc.title	Control charts demonstrated limited utility for the monitoring of lung function in asthma	en_US
dc.type	Journal Article
utslib.citation.volume	1	en_US
utslib.citation.volume	65	en_US
utslib.for	111706 Epidemiology	en_US
utslib.for	01 Mathematical Sciences	en_US
utslib.for	11 Medical and Health Sciences	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Public Health
utslib.copyright.status	closed_access
pubs.issue	1	en_US
pubs.publication-status	Published	en_US
pubs.volume	65	en_US

Abstract:

Objective: Statistical process control charts have been advocated for use in monitoring of lung function in asthma. We aimed to evaluate their application in asthma using existing data from a randomized trial. Study Design and Setting: Patients on optimal inhaled corticosteroid/bronchodilator therapy (n = 81) were randomized to continue the same or change to corticosteroid alone. Baseline statistical control was assessed from 20 days of electronically recorded lung function (peak expiratory flow [PEF], forced expiratory volume in one second [FEV 1]). The ability to detect lung function changes was assessed during 10 days after randomization. Results: PEF measurements were in statistical control during baseline for only 59-79% of patients for different combinations of five control chart rules (e.g., Rule 1: >3 standard deviations outside mean and 95% expected to be in control), with similar proportions for FEV 1. After randomization, among those previously in statistical control, Rule 1 signaled lower FEV 1 for 35% of patients randomized to treatment change compared with 6% continuing baseline treatment (P = 0.004). Control charts performed poorly for PEF, signaling a decrease for 8% of patients randomized to treatment change compared with 11% continuing treatment (P = 0.7). A paradoxical increase was signaled for many patients continuing treatment. Conclusion: Control charts may not be suitable for use in many patients with asthma. © 2012 Elsevier Inc. All rights reserved.

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http://hdl.handle.net/10453/115129