Self-management of asthma in general practice, asthma control and quality of life: a randomised controlled trial

Abstract

Background: A study was undertaken to determine the effectiveness of asthma self-management in general practice. Methods: Nineteen general practices were randomly allocated to usual care (UC) or self-management (SM). Asthma patients were included after confirmation of the GP diagnosis. Follow up was 2 years. Patients kept diary cards and visited the lung function laboratory every 6 months. Outcomes were number of successfully treated weeks, limited activity days, asthma specific quality of life, forced expiratory volume in 1 second (FEV 1 ), FEV 1 reversibility, concentration of histamine provoking a fall in FEV 1 of 20% or more (PC 20 histamine), and amount of inhaled steroids. Results: A total of 214 patients were included in the study (104 UC/110 SM; one third of the total asthma population in general practice); 62% were female. The mean percentage of successfully treated weeks per patient in the UC group was 72% (74/103 weeks) compared with 78% (81/105 weeks) in the SM group (p=0.003). The mean number of limited activity days was 1.2 (95% CI 0.5 to 1.9) in the SM group and 3.9 (95% CI 2.5 to 5.4) in the UC group. The estimated increase in asthma quality of life score was 0.10 points per visit in the UC group and 0.21 points per visit in the SM group (p=0.055). FEV 1 , FEV 1 reversibility, and PC 20 histamine did not change. There was a saving of 217 puffs of inhaled steroid per patient in favour of the SM group (p<0.05). Conclusion: Self-management lowers the burden of illness as perceived by patients with asthma and is at least as effective as the treatment usually provided in Dutch primary care. Self-management is a safe basis for intermittent treatment with inhaled corticosteroids.

Relationship between house dust mite (HDM) allergen exposure level and inhaled corticosteroid dosage in HDM-sensitive asthma patients on a self management program

“…A study using the same self management plan as in the present study showed a saving of more than 200 puffs of ICS per patient over a period of two years in favour of the self management compared to the 'usual care' group [9]. A significantly higher proportion of subjects from the self management group took domestic HDM avoidance measures.…”

“…Most participants used budesonide 200 g via Turbuhaler ® . Details of this plan are described by Thoonen et al [9]. In Box 1 a summary of the self management plan is shown.…”

“…If reinforcement occurs early in the learning process, the adequate behaviour is more easily maintained as subjects feel more selfefficacious. Self management programs can lead to a reduction of the amount of ICS dosage needed [9]. By adjusting the dose of ICS to their self-assessed degree of asthma, patients can use the lowest possible dose of ICS to gain adequate control.…”

Use of Online Self-Management Diaries in Asthma and COPD: A Qualitative Study of Subjects' and Professionals' Perceptions and Behaviors

“…2,5,6,9,10 The few studies that did examine subjects' reasons for using self-management strategies reported explanations such as having a fixed daily routine and following the advice given by their doctor. 11 Reasons for not using self-management strategies included forgetfulness, belief that the medication was ineffective, not feeling any benefit, lack of perceived symptoms, denial that they have asthma, difficulty in using inhalers, inconvenience, fear of adverse effects, embarrassment, and laziness.…”

“…[11][12][13][14] However, patients' reasons, perceptions, and behaviors in relation to using (or not using) self-management diaries remain largely unknown. Because existing studies 2,5,6,[9][10][11][12][13][14] are limited in scope and setting and focus merely on the subject, thus neglecting the role of the caregiver, the findings of these studies may not be transferable between patient types and settings. The aim of this qualitative study was to understand health-care professionals' and subjects' perceptions and behaviors related to selfmanagement diary use.…”