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Gold, incentives and meh

GPs face peak flow meters confusion

A switch to new and more accurate peak flow meters could lead to a surge in steroid prescribing for asthma, after claims that the current meters routinely overestimate lung capacity.

GPs predict 'great confusion' in using the new meters, which are not accompanied by revised peak flow predictions, and significant extra work.

Announcing the new meters, the Medicines and Healthcare Products Regulatory Agency (MHRA) said only that it 'expects' new charts to become available.

The switchover will begin from September 1, when the old type will be phased out. The new meters will read more accurately than the Wright meters currently in use, which 'can over-read in the mid-range by up to 40 per cent', according to MHRA.

It said the Wright meters may have 'falsely reassured patients and their health care professionals, so that corticosteroid therapy, while appropriate, was not prescribed'.

But GPs are alarmed at the absence of new charts and worried about the workload implications of the switch, given that the MHRA has said all patients with a personalised action plan would need their peak flow reassessed.

Dr Mike Thomas, a GP in Minchinhampton, Gloucestershire, and a committee member of the General Practice Airways Group, welcomed the change to more accurate devices but said without revised charts there would be 'great confusion'. He said: 'It will need several weeks of close monitoring, and you may have to draw up a new action plan with the patient.'

The change in meters has been long awaited. Inaccuracies in peak flow devices were first detected in the early 1990s, but the Department of Health refused to act until the scientific understanding of the problem was complete.

But Dr Dermot Ryan, a GP in Loughborough, Leicestershire, who is also on the airways group, said: 'The department has been dragging its feet in an effort to save money – but it probably cost more money than it saved.'

The new devices have a range from 60 to 800 litres per minute.

By Rob Finch

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