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


CONCLUSIONS
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.
Janson
Susan L
SL
Department of Community Health Systems, School of Nursing, University of California, San Francisco 94143-0608, USA. susanj@itsa.ucsf.edu
Fahy
John V
JV
Covington
Jack K
JK
Paul
Steven M
SM
Gold
Warren M
WM
Boushey
Homer A
HA
D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D001249:Asthma / Q000175:diagnosis / Q000378:metabolism* / Q000628:therapy*; D015415:Biomarkers / Q000032:analysis; D004804:Eosinophils / Q000378:metabolism; D005260:Female; D015438:Health Behavior; D006801:Humans; D007249:Inflammation / Q000378:metabolism; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010349:Patient Compliance; D010353:Patient Education as Topic / Q000379:methods*; D011446:Prospective Studies; D012129:Respiratory Function Tests; D012648:Self Care / Q000379:methods*; D013183:Sputum / Q000737:chemistry; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D015415:Biomarkers