Self-management education and regular practitioner review for adults with asthma.
BACKGROUND
A key component of many asthma management guidelines is the recommendation for patient education and regular medical review. A number of controlled trials have been conducted to measure the effectiveness of asthma education programmes. These programmes improve patient knowledge, but their impact on health outcomes is less well established. This review was conducted to examine the strength of evidence supporting Step 6 of the Australian Asthma Management Plan: "Educate and Review Regularly"; to test whether health outcomes are influenced by education and self-management programmes.


OBJECTIVE
The objective of this review was to assess the effects of asthma self-management programmes, when coupled with regular health practitioner review, on health outcomes in adults with asthma.


METHODS
We searched the Cochrane Airways Group trials register and reference lists of articles.


METHODS
Randomised trials of self-management education in adults over 16 years of age with asthma.


METHODS
Trial quality was assessed and data were extracted independently by two reviewers. Study authors were contacted for confirmation.


RESULTS
Twenty-five trials were included. Self-management education was compared with usual care in 22 studies. Self-management education reduced hospitalisations (odds ratio 0.57, 95% confidence interval 0.38 to 0.88); emergency room visits (odds ratio 0.71, 95% confidence interval (0.57 to 0.90); unscheduled visits to the doctor (odds ratio 0.57, 95% confidence interval 0.40 to 0.82); days off work or school (odds ratio 0.55, 95% confidence interval 0.38 to 0. 79); and nocturnal asthma (odds ratio 0.53, 95% confidence interval 0.39 to 0.72). Measures of lung function were little changed. Self-management programmes that involved a written action plan showed a greater reduction in hospitalisation than those that did not (odds ratio 0.35, 95% confidence interval 0.18 to 0.68). People who managed their asthma by self-adjustment of their medications using an individualised written plan had better lung function than those whose medications were adjusted by a doctor.


CONCLUSIONS
Training in asthma self-management which involves self-monitoring by either peak expiratory flow or symptoms, coupled with regular medical review and a written action plan appears to improve health outcomes for adults with asthma. Training programmes which enable people to adjust their medication using a written action plan appear to be more effective than other forms of asthma self-management.
Gibson
P G
PG
Department of Respiratory Medicine, John Hunter Hosptial, Respiratory Medicine, John Hunter Hospital, Locked Bag 1, Hunter Mail Centre, NSW, Australia, 2310. mdpgg@mail.newcastle.edu.au
Coughlan
J
J
Wilson
A J
AJ
Abramson
M
M
Bauman
A
A
Hensley
M J
MJ
Walters
E H
EH
D000328:Adult; D001249:Asthma / Q000534:rehabilitation / Q000628:therapy*; D006801:Humans; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic; D012648:Self Care