Quality of Life Assessment after Patient Education in a Randomized Controlled Study on Asthma and Chronic Obstructive Pulmonary Disease

Abstract

The effect of patient education in patients with asthma and Chronic Obstructive Pulmonary Disease (COPD) on health-related quality of life (HRQoL) is not previously investigated using the St. George's Respiratory Questionnaire (SGRQ). We randomly allocated at our out-patient clinic 78 asthmatics and 62 patients with COPD to either a control or an intervention group. Intervention consisted of two 2-h group sessions and one to two individual sessions each by a nurse and a physiotherapist. A self-management plan was developed. Baseline quality of life assessment showed comparable scores independent of treatment groups among asthmatics and patients with COPD, but statistically significantly better scores (p < 0.05) for the educated asthma group after 12 mo compared with the control group. This aligned with the 12-mo SGRQ assessment, which revealed better symptoms, activity, impact, and total scores by 11 (p < 0.02), 15 (p < 0.01), 19 (p < 0.001), and 16 (p < 0.001) units, respectively. Patient education among asthmatics increased the FEV1 by a mean value of 6.1% (SD, 12) compared with the control group (p < 0.05). Education among patients with COPD did not indicate a significant increase in HRQoL as measured by the SGRQ or increased FEV1. We conclude that patient education increased HRQoL and FEV1 among asthmatics, but not among patients with COPD.

Cost-effectiveness of self-management in asthmatics: a 1-yr follow-up randomized, controlled trial

“…Wording of the questions and the preprinted alternatives for answering were: 1) The last year my chest trouble has become: Worse, unchanged or , better; 2) The last two weeks I have had asthma symptoms during the day: All the time, 2 -4 times a day, every day, 2 -3 times a week or , more seldom; 3) The last two weeks I have had asthma symptoms during the night: Waken 3 times or more, waken 1 -2 times or , do not wake up; 4) My asthma has the last two weeks restricted me from doing what I want: To a great extent, medium extent or , little or no extent. Regarding the responses to these questions, the two groups were comparable at baseline [15]. The same four questions were repeated at the 1-yr follow-up.…”

“…The present asthma education programme has been shown, in a 12 month follow-up, to improve quality of life, level of lung function [15] and compliance to inhaled corticosteroids [16] as well as reducing GP consultation rates and absenteeism from work [17] due to asthma. Based on these data, estimated the costeffectiveness ratios of patient education choosing St. George9s Respiratory Questionnaire (SGRQ) total score, FEV1 and number needed to educate (NNE) to make one person symptom free as clinically important effectiveness measures were calculated.…”

The use of the self-management plan system of care in adult asthma

“…Utilising a measure of corticosteroid inhaler compliance based on the ratio of dispensed to prescribed therapy over a 12-month period, the median compliance in the self-management group was 82% compared with 55% in the control group. This greater level of compliance was associated with an improved clinical outcome [11] and was cost-effective [17].…”

“…Thus, self-management plans can be considered to provide practical guidelines in which the recommendations for acute se- vere and chronic persistent asthma can be brought together within the framework of one system. The basic structure of this standardised prototype plan has been used in most studies which have assessed the efficacy of this form of care [1,[6][7][8][9][10][11][12][13].…”

“…There are now a number of studies which indicate that primary responsibility for the introduction and supervision of this system can be undertaken by a nurse practitioner, working in partnership with a medical practitioner [11,13,27]. This illustrates that whatever plan is employed, it needs to reflect the medical practice, resources and health care system of the community in which it is introduced and must be tailored to meet the specific needs of individual patients.…”