title: Randomized trial of self-management education in asthmatic patients and effects of depressive symptoms.
abstract: BACKGROUND
  Self-management education is a cornerstone of routine asthma care.
  
  
  OBJECTIVE
  To improve asthma knowledge and self-efficacy and to assess effects in patients with depressive symptoms.
  
  
  METHODS
  In a randomized trial, controls received asthma brochures and social support through frequent follow-up visits. Intervention patients made a contract to adopt a behavior to improve asthma and received a workbook, weekly reinforcements for 12 weeks, and frequent follow-up visits. Outcomes were Asthma Quality of Life Questionnaire (AQLQ) and 36-Item Short Form Health Survey (SF-36) scores and emergency department (ED) visits and hospitalizations for asthma.
  
  
  RESULTS
  Ninety patients were randomized to each group. Mean age was 43 years, 84% were women, and mean study time was 27 months. Intervention patients had more improvement in AQLQ scores at 5 months, but this difference was not sustained. For the entire period, AQLQ scores improved by a clinically important difference from 4.1 to a mean of 5.1 in both groups (P < .001) with no difference between groups (P = .91). In multivariate analysis, younger age, more education, better enrollment AQLQ score, more asthma self-efficacy and knowledge, and fewer depressive symptoms were associated with more improvement (P < .05 for all). Similar results were found for the SF-36. Thirty-one percent of patients had an ED visit, and 9% were hospitalized, with no differences between groups. In multivariate analysis, female sex, expecting to be cured of asthma, less asthma knowledge, and more depressive symptoms were associated with ED visits. Being in the intervention group attenuated the effects of depressive symptoms for all outcomes.
  
  
  CONCLUSIONS
  Quality of life improved in both groups, with particular benefit in intervention patients with depressive symptoms.
authors.affiliation: Department of Medicine, Research Division, Hospital for Special Surgery, New York, NY 10021, USA. mancusoc@hss.edu
authors.forename: Carol A
authors.initials: CA
authors.lastname: Mancuso
authors.forename: Wendy
authors.initials: W
authors.lastname: Sayles
authors.forename: John P
authors.initials: JP
authors.lastname: Allegrante
mesh_terms: D000328:Adult; D001249:Asthma / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D003863:Depression; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D011788:Quality of Life; D012307:Risk Factors; D012648:Self Care; D011795:Surveys and Questionnaires