Clinical study
Effects of individual self-management education on clinical, biological, and adherence outcomes in asthma

https://doi.org/10.1016/j.amjmed.2003.07.008Get rights and content

Abstract

Background

Asthma guidelines urge teaching patients the knowledge and skills required for self-management, based on the assumption that education will lead to improved skills and better asthma control.

Methods

In a prospective, randomized controlled trial of 65 adults with mild-to-moderate asthma, we examined whether an educational self-management intervention would improve adherence to inhaled corticosteroid therapy, decrease markers of airway inflammation, and improve clinical control. Peak flow, symptoms, and adherence were monitored for 7 weeks. After a 1-week run-in, subjects were assigned randomly to either the educational intervention or control group. The 30-minute intervention was delivered and reinforced at biweekly intervals.

Results

Compared with the control group, the intervention group had improvements in adherence to inhaled corticosteroid therapy (by 30% vs. −5%, P = 0.01), self-reported control of asthma (by 14% vs. 5%, P = 0.04), and perhaps quality of life (by 37% vs. 21%, P = 0.06). The direction of change for all other clinical outcomes was more favorable in the intervention group, but not significantly so. Markers of inflammation in sputum decreased more in the intervention group, with sputum eosinophils declining significantly (P = 0.02).

Conclusion

In asthmatic patients treated with inhaled corticosteroids, education and training in self-management improves adherence with inhaled therapy, perceived control of asthma, and sputum eosinophilia.

Section snippets

Study design

We conducted a prospective, randomized controlled trial of an individually delivered asthma educational self-management intervention in adults with mild-to-moderate asthma who were treated with an inhaled corticosteroid. We assessed adherence with inhaled corticosteroid medication using an electronic recording device (Doser; NewMed Corp., Newton, Massachusetts); the intensity of airway inflammation by measuring the constituents of induced sputum; and asthma control by measuring the frequency of

Results

Of 224 adults with asthma who were screened, 68 met study criteria, gave written informed consent, and were enrolled in the study. The most common reasons for exclusion were a history of smoking or inadequate bronchial hyperresponsiveness to inhaled methacholine. Two subjects (1 in each group) developed asthma exacerbations during the study and withdrew, and 1 (in the control group) withdrew because of time constraints. The final sample included 65 subjects: 62 with complete data for all time

Discussion

Our results suggest that asthma education is beneficial, even among patients who monitor their asthma. Although the subjects in the control group recorded peak flow and completed diaries as often as did subjects in the intervention group, they did not improve adherence to inhaled corticosteroids. However, the control group did not wane in adherence, as has been seen in recent observational studies 22, 23. Indeed, compliance was often better than expected in clinical trials, which may account

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    This project was supported by funding from the National Institutes of Health (NR3995), Bethesda, Maryland.

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