Asthma self management in adults: A review of current literature

Andrews, Kelly; Jones, Sandra C.; Mullan, Judy

doi:10.1016/j.colegn.2012.12.005

Cited by 36 publications

(35 citation statements)

References 67 publications

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“…By making the asthma review more holistic, structured and focussed, the tool improved their ability to communicate and increased their belief in becoming more active self-managers [43, 44]. However, the need for self-management strategies was related to perceived severity of disease [29, 30, 33, 34]; the general view was that the intervention should be targeted to people with more severe asthma.…”

Section: Discussionmentioning

confidence: 99%

“…However, they do not incorporate the wider needs and views of the individuals who have to integrate the management of the disease into their daily lives. This exclusive medical focus can lead to a breakdown in communication and a failure of individuals with asthma to engage effectively in self-management [34, 35]. Divergent perceptions of asthma and how to manage it, and a mismatch between what patients want and need from plans and what is provided by professionals, are barriers to success [29, 30, 33].…”

Section: Introductionmentioning

confidence: 99%

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Achieving Good Outcomes for Asthma Living (GOAL): mixed methods feasibility and pilot cluster randomised controlled trial of a practical intervention for eliciting, setting and achieving goals for adults with asthma

Hoskins

Williams

Abhyankar

et al. 2016

Trials

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BackgroundDespite being a core component of self-management, goal setting is rarely used in routine care. We piloted a primary care, nurse-led intervention called Achieving Good Outcomes for Asthma Living (GOAL) for adults with asthma. Patients were invited to identify and prioritise their goals in preparation for discussing and negotiating an action/coping plan with the nurse at a routine asthma review.MethodsThe 18-month mixed methods feasibility cluster pilot trial stratified and then randomised practices to deliver usual care (UC) or a goal-setting intervention (GOAL). Practice asthma nurses and adult patients with active asthma were invited to participate. The primary outcome was asthma-specific quality of life. Semi-structured interviews with a purposive patient sample (n = 14) and 10 participating nurses explored GOAL perception. The constructs of normalisation process theory (NPT) were used to analyse and interpret data.ResultsTen practices participated (five in each arm), exceeding our target of eight. However, only 48 patients (target 80) were recruited (18 in GOAL practices). At 6 months post-intervention, the difference in mean asthma-related quality of life (mAQLQ) between intervention and control was 0.1 (GOAL 6.20: SD 0.76 (CI 5.76–6.65) versus UC 6.1: SD 0.81 (CI 5.63–6.57)), less than the minimal clinically important difference (MCID) of 0.5. However, change from baseline was stronger in the intervention group: at 6 months the change in the emotions sub-score was 0.8 for intervention versus 0.2 for control. Costs were higher in the intervention group by £22.17.Routine review with goal setting was considered more holistic, enhancing rapport and enabling patients to become active rather than passive participants in healthcare. However, time was a major barrier for nurses, who admitted to screening out patient goals they believed were unrelated to asthma.ConclusionsThe difference in AQLQ score from baseline is larger in the intervention arm than the control, indicating the intervention may have impact if appropriately strengthened. The GOAL intervention changed the review dynamic and was well received by patients, but necessitated additional time, which was problematic in the confines of the traditional nurse appointment. Modification to recruitment methods and further development of the intervention are needed before proceeding to a definitive cluster randomised controlled trial.Trial registration ISRCTN18912042. Registered on 26 June 2012.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1684-7) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Achieving Good Outcomes for Asthma Living (GOAL): mixed methods feasibility and pilot cluster randomised controlled trial of a practical intervention for eliciting, setting and achieving goals for adults with asthma

Hoskins

Williams

Abhyankar

et al. 2016

Trials

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“…For adults with asthma, effective asthma self-management education can provide the knowledge and skills needed to control the symptoms of asthma and improve asthma-related outcomes [1,2,16–18]. Results from both observational and experimental research provide evidence that targeted self-management education can improve self-management skills [19], medication adherence [20,21], and some indicators of asthma control [17–21].…”

Section: Discussionmentioning

confidence: 99%

Age at asthma onset and asthma self-management education among adults in the United States

2015

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Objective Asthma self-management education improves asthma-related outcomes. We conducted this analysis to evaluate variation in the percentages of adults with active asthma reporting components of asthma self-management education by age at asthma onset. Methods Data from 2011 to 2012 Asthma Call-back Surveys were used to estimate percentages of adults with active asthma reporting six components of asthma self-management education. Components of asthma self-management education include having been taught to what to do during an asthma attack and receiving an asthma action plan. Differences in the percentages of adults reporting each component and the average number of components reported across categories of age at asthma onset were estimated using linear regression, adjusted for age, education, race/ethnicity, sex, smoking status, and years since asthma onset. Results Overall, an estimated 76.4% of adults with active asthma were taught what to do during an asthma attack and 28.7% reported receiving an asthma action plan. Percentages reporting each asthma self-management education component declined with increasing age at asthma onset. Compared with the referent group of adults whose asthma onset occurred at 5–14 years of age, the percentage of adults reporting being taught what to do during an asthma attack was 10% lower among those whose asthma onset occurred at 65–93 years of age (95% CI: −18.0, −2.5) and the average number of components reported decreased monotonically across categories of age at asthma onset of 35 years and older. Conclusions Among adults with active asthma, reports of asthma self-management education decline with increasing age at asthma onset.

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“…High rates of urgent care use for asthma are associated with residing in low income and minority communities [8][9][10]. A variety of ways have been examined in which to improve services, provide selfmanagement support to patients and reduce the demand for more expensive asthma care [11][12]. One way discussed in the literature is formation of community-wide asthma coalitions [13].…”

Section: Introductionmentioning

confidence: 99%

Asthma coalition effects on vulnerable sub groups of children: the most frequent users of health care and the youngest

et al. 2014

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Asthma self management in adults: A review of current literature

Cited by 36 publications

References 67 publications

Achieving Good Outcomes for Asthma Living (GOAL): mixed methods feasibility and pilot cluster randomised controlled trial of a practical intervention for eliciting, setting and achieving goals for adults with asthma

Achieving Good Outcomes for Asthma Living (GOAL): mixed methods feasibility and pilot cluster randomised controlled trial of a practical intervention for eliciting, setting and achieving goals for adults with asthma

Age at asthma onset and asthma self-management education among adults in the United States

Asthma coalition effects on vulnerable sub groups of children: the most frequent users of health care and the youngest

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