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Patient adherence needs to be considered in relation to peak flow monitoring. Selected patients reliably monitor peak flows over a limited period . However, these results cannot be generalized to patients with asthma who are based in the community rather than a hospital clinic , in whom manual records were markedly deficient compared with electronic records. As well as factitious readings, there were errors in reading and transcribing; the completeness of the record declined from the first to the third week. In a three-month study of PEF monitoring, adherence decreased rapidly after two weeks . Cote et al have shown that even after receiving asthma education and with regular reinforcement, compliance with peak flow monitoring (50% of measurements done) fell from 60% in the first three months to 30% at one year. More important, peak flow meter use during an acute exacerbation is also disappointing; only 25% to 50% of patients who have a peak flow meter actually use it in the event of an acute severe attack .