title: Asthma morbidity 6 yrs after an effective asthma self-management programme in a Maori community.
abstract: A 6-month Maori community-based asthma self-management programme, involving a "credit card" asthma self-management plan, has previously been shown to be an effective and acceptable system for reducing asthma morbidity. The effectiveness of the asthma self-management programme and participants' self-management behaviour was assessed 6 yrs after the formal end of the programme. Participants were surveyed at the time of enrollment, and 1, 2, and 6 yrs after completing the programme. In each survey, participants were questioned on markers of asthma morbidity and use of medical services during the previous 12 months. Self-management behaviour was assessed using a questionnaire at 2 years and 6 yrs. Of the 69 original participants, 47 (68%) were surveyed after 6 yrs. They generally had reduced severe asthma morbidity and emergency use of health services from baseline. In particular, the proportion who had an emergency visit to a general practitioner had decreased from 41% to 18% (p=0.02). However, the percentage of nights woken due to asthma had returned to preintervention levels, and the proportion of participants taking prescribed regular inhaled steroid had decreased from 91% to 53% (p<0.001). Compared with 2 yrs after completion of the asthma programme, self-management behaviour had also deteriorated, with 29% versus 73% (p<0.001) using their peak flow meter daily when their asthma was "getting bad" and 41% versus 86% (p<0.001) using the "credit card" plan to increase the amount of inhaled steroids in the last year. Although the programme participants were still experiencing reduced morbidity from their asthma 6 yrs after the end of the self-management programme, the benefits were less than those observed at 2 yrs. These findings suggest that under-recognition and under-treatment of asthma with appropriate amounts of inhaled steroids is a major factor contributing to asthma morbidity in this indigenous rural community. To obtain enduring benefits from a self-management system of care continued reinforcement of self-management skills seems to be an essential component of any follow-up.
authors.affiliation: Wellington Asthma Research Group, Dept of Medicine, Wellington School of Medicine, New Zealand.
authors.forename: W J
authors.initials: WJ
authors.lastname: D'Souza
authors.forename: T
authors.initials: T
authors.lastname: Slater
authors.forename: C
authors.initials: C
authors.lastname: Fox
authors.forename: B
authors.initials: B
authors.lastname: Fox
authors.forename: H
authors.initials: H
authors.lastname: Te Karu
authors.forename: T
authors.initials: T
authors.lastname: Gemmell
authors.forename: M M
authors.initials: MM
authors.lastname: Ratima
authors.forename: N E
authors.initials: NE
authors.lastname: Pearce
authors.forename: R B
authors.initials: RB
authors.lastname: Beasley
mesh_terms: D000328:Adult; D001249:Asthma / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009520:New Zealand; D010358:Patient Participation; D015397:Program Evaluation; D013997:Time Factors