A self-management program for adult asthma. Part I: Development and evaluation

Kotses, Harry; Bernstein, I. Leonard; Bernstein, David I.; Reynolds, Russ V.; Korbee, Leslie; Wigal, Joan K.; Ganson, Ellen; Stout, Cindy; Creer, Thomas L.

doi:10.1016/s0091-6749(95)70315-2

Cited by 136 publications

(63 citation statements)

References 21 publications

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“…The application of new behavioural strategies to deal with asthma has yielded positive changes in cognitive, behavioural, affective and respiratory parameters. KOTSES et al [38] have obtained similar results in patients with moderate-to-severe asthma who had received appropriate medical attention before they entered the study.…”

Section: Discussionmentioning

confidence: 64%

Evaluation of an individualised asthma programme directed at behavioural change

Put¹,

Bergh²,

Lemaigre³

et al. 2003

Eur Respir J

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An individualised asthma programme directed at behavioural change was evaluated in asthmatic subjects who reported complaints and impairment, despite adequate medical treatment.Mild-to-moderate asthma patients (n=23) were randomly assigned to a programme or waiting list condition. Outcome measures were: McMaster Asthma Quality of Life Questionnaire, Asthma Symptom Checklist, Negative Emotionality Scale, Knowledge, Attitude and Self-Efficacy Asthma Questionnaire, Adherence Scale, and peak flow measurements. Both groups were evaluated at three consecutive moments, each separated by 3 months; the programme was delivered between the first two evaluations. At onset the patient received a workbook containing information, exercises and homework assignments. Psycho-education, behavioural and cognitive techniques were introduced during six 1-h individual sessions.Compared with controls the programme group reported less symptoms (obstruction, fatigue), better quality of life (activity, symptoms, emotions), decreased negative affectivity, and increased adherence, immediately after finishing the programme and at 3 months follow-up. All three cognitive variables (knowledge, attitude towards asthma, self-efficacy) and day and night peak flow ratings improved in the programme group but not in the waiting list group.Participation in an individualised programme resulted in improvement of asthma morbidity, and asthma-related behaviour and cognitions, in subjects reporting symptoms and impairment despite adequate medical therapy. In addition to pharmacological therapy, education and self-management have become indispensable aspects in the treatment of asthma. In order to assist patient and physician in the integration of medical and behavioural therapeutic instructions, self-management programmes were developed [1,2]. By means of education and behavioural techniques, these programmes enhance the patient9s sense of self-control, personal responsibility for the treatment, and consider physician and patient as partners in the management of asthma.Several kinds of asthma programme have been developed, differing in terms of treatment components and outcome. Educating asthmatic subjects, or providing information on the pathophysiology of the illness and medication, results in increase of knowledge but not behavioural change nor decreased morbidity [3]. The development of step-care approaches to asthma management has been an important step towards simplification of asthma treatment. In this case, patients receive instructions consisting of treatment levels starting from baseline therapy, and ending up with consulting an emergency department, depending on the severity of their illness. The two most common elements of existing asthma programmes are education in addition to a self-management action plan for medication intake [4][5][6]. Therapeutic action plans can be based on changes in symptoms or changes in peakexpiratory flow rate (PEFR) [7][8][9][10]. In addition to self-management medical action plans and/or education, some p...

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Section: Discussionmentioning

confidence: 64%

Evaluation of an individualised asthma programme directed at behavioural change

Put¹,

Bergh²,

Lemaigre³

et al. 2003

Eur Respir J

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“…Non-specific action plans led to an improvement in knowledge, 33 36 37 symptoms, 35 36 and reduced healthcare use in some 35 but not other studies. 29 Incomplete data reporting precluded meta-analysis.…”

Section: Incomplete/non-specific Plansmentioning

confidence: 89%

Written action plans for asthma: an evidence-based review of the key components

Gibson

Powell²

2004

Thorax

378

318

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Background: Written action plans for asthma facilitate the early detection and treatment of an asthma exacerbation. Several versions of action plans have been published but the key components have not been determined. A study was undertaken to determine the impact of individual components of written action plans on asthma health outcomes. Methods: Randomised controlled trials (n = 26) that evaluated asthma action plans as part of asthma selfmanagement education were identified. Action plans were classified as being individualised and complete if they specified when and how to increase treatment (n = 17), and as incomplete (n = 4) or non-specific (n = 5) if they did not include these instructions. Results: For individualised complete written action plans the use of 2-4 action points and the use of both inhaled (ICS) and oral (OCS) corticosteroid consistently improved asthma outcomes. Action points based on personal best peak expiratory flow (PEF) consistently improved health outcomes while those based on percentage predicted PEF did not. The efficacy of incomplete action plans was inconclusive because of insufficient data. Non-specific action plans led to improvements in knowledge and symptoms. Conclusion: Individualised written action plans based on personal best PEF, using 2-4 action points, and recommending both ICS and OCS for treatment of exacerbations consistently improve asthma health outcomes. Other variations appear less beneficial or require further study. These observations provide a guide to the types of variations possible with written action plans, and strongly support the use of individualised complete written action plans.

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“…A number of previous studies, including a controlled trial conducted by the present authors9 group [15], have demonstrated that training in asthma selfmanagement that involves self-monitoring by either PEFR or symptoms appears to improve health outcomes for adults with asthma, at least in the short term [2][3][4][5][6][7][8][9][10][11][12][13][14][16][17][18][19][20][21][22][23][24][25][26][27]. Training programmes which enable people to adjust their medication using a written action plan appear to be more effective than other forms of asthma self-management [25].…”

Section: Discussionmentioning

confidence: 99%

Benefits at 3 yrs of an asthma education programme coupled with regular reinforcement

Ignacio-Garcia¹,

Pinto-Tenorio²,

Chocrón-Giraldez³

et al. 2002

Eur Respir J

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The benefits at 3 yrs of an asthma self-management education programme coupled with educational reinforcement were assessed at follow-up visits in 63 adults with chronic asthma.Changes in asthma-related morbidity parameters, lung function and use of different classes of drugs before intervention and after 1, 2 and 3 yrs of the asthma education programme were compared using Friedman one-way analysis of variance.Improvements in the number of days off work or school, general practitioner consultations, admissions to emergency services, hospital admissions and nocturnal awakenings, as well as increases in forced expiratory volume in one second (FEV1), were significant. Comparison of data obtained at 1 yr and 2–3 yrs showed significant differences in the number of asthma-associated sleep disruptions, days off work or school and unscheduled visits to the general practitioner, as well as FEV1, but significant differences between the data obtained at 2 and 3 yrs were not observed. The percentage of patients using oral steroids had decreased significantly at 3 yrs.In adults with chronic asthma, an asthma self-management education programme coupled with educational reinforcement was effective at decreasing asthma morbidity, improving lung function and decreasing consumption of oral steroids.

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A self-management program for adult asthma. Part I: Development and evaluation

Cited by 136 publications

References 21 publications

Evaluation of an individualised asthma programme directed at behavioural change

Evaluation of an individualised asthma programme directed at behavioural change

Written action plans for asthma: an evidence-based review of the key components

Benefits at 3 yrs of an asthma education programme coupled with regular reinforcement

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