Evaluation of an individualised asthma programme directed at behavioural change

Abstract

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...

Psychological Interventions in Asthma

“…Characteristics and content of interventions varied even within broad therapy types, and unfortunately, methodological quality was generally poor. [44], symptoms and respiratory function [34], panic attacks and anxiety symptoms and peak flow [35]. Psycho-educational interventions may improve self-management, reduce hospital admissions in adults and children and improve symptoms in children, but these positive effects observed from qualitative and quantitative syntheses were all short-term.…”

“…In the individual trials, the following positive outcomes were reported: and improved self-efficacy (MD 11.80 95 % CI 6.64 to 16.96) [31] Given the wide variety of outcome measures used across these 15 trials, the possibility of meta-analyses was limited. However, three potentially promising results did emerge regarding biofeedback improving lung function (PEFR) [30,32], cognitive behaviour therapy improving quality of life [34,35] and relaxation therapy improving medication use [23,31]. No therapy impacted on health service utilization or any other measure of frequency, duration or severity of asthma symptoms.…”

“…Seventeen studies were included which were divided into four categories: four self-management [37][38][39][40], three as educational [41][42][43], three as psychosocial [34,35,44] and seven as multi-faceted involving a combination of approaches [45][46][47][48][49][50][51]. Characteristics and content of interventions varied even within broad therapy types, and unfortunately, methodological quality was generally poor.…”

“…The range of interventions studied was diverse; nine trials included one of six types of relaxation therapy [22][23][24][25][26][27][28][29][30][31]; four studies used behavioural therapy [30,[32][33][34] (three explicitly used biofeedback [30,32,33]; three incorporated cognitive behavioural therapy [28,35,36], one written emotional disclosure [28] and one included psychoeducational techniques [34]. The trials were generally small (range 12 to 106 patient), totalling 687 patients between them.…”

Impacto de uma intervenção educacional de curta duração sobre a adesão ao tratamento e controle da asma

“…Such programs differ in terms of approach, setting in which the disease is addressed, and outcomes considered. (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) There is a real need to adapt this knowledge about asthma education to clinical practice and to make it accessible at public outpatient clinics specializing in asthma. That need motivated us to develop a project in which the impact that a short-term educational intervention has on asthma management would be evaluated.…”