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On the other hand, an objective measure of airflow obstrucion is crucial if there is concern that the deterioration in symptoms is due to conditions other than asthma, such as disordered breathing or hyperventilation. Some physicians may be more comfortable basing decisions regtarding use of oral steroids on a quantitative measure rather than on symptoms alone. Routine daily monitoring of peak flow cannot generally be recommended. Use of peak flow monitoring should be discretionary, and limited to two- to four-week periods of monitoring for the purposes of diagnosis, education, assessment of control, determination of best PEF and assessment of response to therapy or another intervention. There may be a role for the use of peak flow monitoring in conjunction with a written action plan in the context of an exacerbation in some patients. Lending patients a peak flow meter for a few weeks may be a satisfactory way of teaching the importance and relevance of their symptoms that can subsequently form the basis of the self-management plan. As the patients’ perception and interpretation of symptoms improve, the value of peak flow monitoring probably declines. Rapid onset asthma: Published evidence suggests that the vast majority of attacks causing death, severe life-threatening asthma (SLTA) or hospital admission develop over a number of hours, are thus theoretically identifiable and preventable by strategies contained within the action plan (Figure 3 ). However, a small proportion of patients (less than 10%) presents with acute severe asthma of rapid onset (less than 6 h). Such patients were more likely to be male, to present with SLTA and to have had a past history of intensive care unit admission for asthma . Rapid onset attacks were not associated with conventional risk factors for SLTA and death . Such patients need to be identified and different selfmanagement strategies (from those contained within the usual action plan) employed. Figure 3) Scenarios of asthma death and severe life-threatening asthma (SLTA). Adapted from reference 51