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

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 (FEV1), FEV1 reversibility, concentration of histamine provoking a fall in FEV1 of 20% or more (PC20 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). FEV1, FEV1 reversibility, and PC20 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.

[1]  Arl Medford,et al.  British Thoracic Society , 2004 .

[2]  A. Bhowmik.  Decreases in air pollutants may lead to lower cardiopulmonary mortality , 2003 .

[3]  D. Dockery,et al.  Effect of air-pollution control on death rates in Dublin, Ireland: an intervention study , 2002, The Lancet.

[4]  R. Grol,et al.  Asthma education tailored to individual patient needs can optimise partnerships in asthma self-management. , 2002, Patient education and counseling.

[5]  C. Weel,et al.  Role of Family Physicians in Implementing Asthma Self-Management Programs , 2002 .

[6]  R. Grol,et al.  Willingness of patients to perform self-management of asthma and the role of inhaled steroids , 2002, Scandinavian journal of primary health care.

[7]     ,et al.  NHG-Standaard COPD en Astma bij Volwassenen: Diagnostiek , 2001 .

[8]  C. van Weel,et al.  Perception of bronchoconstriction in asthma patients measured during histamine challenge test. , 1999, The European respiratory journal.

[9]  M. Abramson,et al.  Comparison of patients with asthma managed in general practice and in a hospital clinic , 1999, The Medical journal of Australia.

[10]  R. Grol,et al.  Self-treatment of asthma: possibilities and perspectives from the practitioner's point of view. , 1999, Family practice.

[11]  M. Pringle,et al.  Morbidity from asthma in relation to regular treatment: a community based study , 1999, Thorax.

[12]  J. J. Klein,et al.  Self-management of asthma by adults : development and evaluation of a program with an emphasis on self-treatment of exacerbations , 1998 .

[13]  B. Everitt,et al.  Analysis of longitudinal data , 1998, British Journal of Psychiatry.

[14]  J. J. Klein,et al.  Self-management of asthma by adults , 1998 .

[15]  S. Vožeh.  Pharmacokinetics of inhaled drugs. , 1997, British journal of clinical pharmacology.

[16]  The British Guidelines on Asthma Management1995 Review and Position Statement , 1997 .

[17]  Ivo Smeele,et al.  COPD en astma bij volwassenen: Diagnostiek. NHG-standaard , 1997 .

[18]  C. P. V. Schayck,et al.  Astma bij volwassenen: behandeling. NHG-standaard , 1997 .

[19]  R. Pauwels,et al.  GLOBAL STRATEGY FOR ASTHMA MANAGEMENT AND PREVENTION , 1996 .

[20]  R. Littell.  SAS System for Mixed Models , 1996 .

[21]  H. R. Anderson,et al.  A computer-assisted telephone interview technique for assessment of asthma morbidity and drug use in adult asthma. , 1996, Journal of clinical epidemiology.

[22]  R. Bone,et al.  Goals of asthma management. A step-care approach. , 1996, Chest.

[23]  R. Neville,et al.  Do self-management plans reduce morbidity in patients with asthma? , 1996, The British journal of general practice : the journal of the Royal College of General Practitioners.

[24]  Cochrane Gm.  Compliance and Outcomes in Patients with Asthma , 1996 .

[25]  G. Cochrane.  Compliance and outcomes in patients with asthma. , 1996, Drugs.

[26]  C. van Weel,et al.  Treatment of mild asthma with inhaled corticosteroids: is discontinuation of therapy possible? , 1996, Family medicine.

[27]  S T Holgate,et al.  Peak flow based asthma self-management: a randomised controlled study in general practice. British Thoracic Society Research Committee. , 1995, Thorax.

[28]  C. van Weel,et al.  Periodic treatment regimens with inhaled steroids in asthma or chronic obstructive pulmonary disease. Is it possible? , 1995, JAMA.

[29]  D. Parry,et al.  Patient compliance with inhaled medication: does combining beta-agonists with corticosteroids improve compliance? , 1994, The European respiratory journal.

[30]  S. A. O'Connor,et al.  Compliance with prescribed drug therapy in asthma. , 1994, Respiratory medicine.

[31]  K P Jones,et al.  Guidelines on the management of asthma. , 1993, Thorax.

[32]  G. Guyatt,et al.  Measuring quality of life in asthma. , 1993, The American review of respiratory disease.

[33]  S. Anderson,et al.  Airway responsiveness : standardized challenge testing with pharmacological, physical and sensitizing stimuli in adults , 1993 .

[34]  Z. Tomori,et al.  Comparison of inspiratory effort in sniff-like aspiration reflex, gasping and normal breathing in cats. , 1993, The European respiratory journal.

[35]  C. van Weel,et al.  Treatment with inhaled steroids in asthma and chronic bronchitis: long-term compliance and inhaler technique. , 1992, Family practice.

[36]  G. Guyatt,et al.  Evaluation of impairment of health related quality of life in asthma: development of a questionnaire for use in clinical trials. , 1992, Thorax.

[37]  D. Dacruz,et al.  Guidelines for management of asthma. , 1990, BMJ.

[38]  T. Clark,et al.  Compliance with inhaled therapy and morbidity from asthma. , 1990, Respiratory medicine.