RATIONALE: Asthma clinical guidelines suggest written asthma action plans are essential for improving self-management and outcomes.
OBJECTIVES: To assess the efficacy of written instructions in the form of a written asthma action plan provided by subspecialist physicians as part of usual asthma care during office visits.
METHODS: A total of 407 children and adults with persistent asthma receiving first-time care in pulmonary and allergy practices at 4 urban medical centers were randomized to receive either written instructions (n = 204) or no written instructions other than prescriptions (n = 203) from physicians.
MEASUREMENTS AND MAIN RESULTS: Using written asthma action plan forms as a vehicle for providing self-management instructions did not have a significant effect on any of the primary outcomes: (1) asthma symptom frequency, (2) emergency visits, or (3) asthma quality of life from baseline to 12-month follow-up. Both groups showed similar and significant reductions in asthma symptom frequency (daytime symptoms [P < 0.0001], nocturnal symptoms [P < 0.0001], β-agonist use [P < 0.0001]). There was also a significant reduction in emergency visits for the intervention (P < 0.0001) and control (P < 0.0006) groups. There was significant improvement in asthma quality-of-life scores for adults (P < 0.0001) and pediatric caregivers (P < 0.0001).
CONCLUSIONS: Our results suggest that using a written asthma action plan form as a vehicle for providing asthma management instructions to patients with persistent asthma who are receiving subspecialty care for the first time confers no added benefit beyond subspecialty-based medical care and education for asthma. Clinical trial registered with www.clinicaltrials.gov (NCT 00149461).
INTRODUCTION: Recently published national and international guidelines stress the importance of self-management in asthma. They have recommended that self-management plans should be an essential part of the long-term management of asthmatic patients. These plans essentially focus on the early recognition of unstable or deteoriorating asthma, by monitoring peak flow or symptoms.
OBJECTIVE: The aim of our one-year study was to compare the efficacy of peak-flow based self-management of asthma with traditional treatment.
METHOD: Sixty clinically stable adult patients with mild and moderate persistent asthma were randomly allocated to peak-flow based self-management (Group A, n=30) or to conventional treatment (Group B, n=30), with no significant difference between groups in terms of age, sex distribution and initial lung function. The recorded measurements were: lung function, asthma exacerbations, unscheduled ambulatory care facilities (hospital-based emergency department, consultations with general practitioner or pulmonologist), courses of oral prednisolone, courses of antibiotics, days off work.
RESULTS: There was a significant difference between groups in number of asthma exacerbations (p < 0.05), unscheduled visits to ambulatory care facilities (p < 0.005), days off work (p < 0.0001), courses of oral prednisolone (p < 0.001) and antibiotics (p < 0.05). At the final visit, there was a significant improvement in some measurements of asthma severity in group A (reduced unscheduled visits for ambulatory care, reduced treatment requirements for oral corticosteroids and antibiotics, reduced days off work), but a lack of statistical difference in lung function and the maintenance-inhaled corticosteroid dose. There was no significant change in group B.
CONCLUSION: These results suggest that peak-flow based self-management is more effective than traditonal treatment in mild and moderate persistent asthma.
The aims of this study were to compare the efficacy of 1-year peak expiratory flow (PEF)-based self-management of asthma against conventional treatment and to analyze the long-term effectiveness of self-management. Eighty adult patients with persistent asthma (group B). After 1 year, significant improvement was noted in markers of asthma severity in group A but there were no changes in group B. After 6 years of the self-management program, asthma morbidity and emergency use of health services were reduced. These results show short-term and long-term effectiveness of a PEF-based self-management program in persistent asthma.
ANTECEDENTES: El uso excesivo de beta-agonistas es un factor de riesgo para el mal control del asma. Los farmacéuticos pueden identificar a los pacientes de alto riesgo a través de información de relleno y luego pueden iniciar programas de control de la enfermedad en estos pacientes. Métodos: El mejor educación respiratoria y el tratamiento del asma en Hinton y Edson (tomar aire) estudio fue un ensayo aleatorio y controlado en pacientes de alto riesgo de asma. La intervención incluyó un programa educativo (con enfoque en el desarrollo de un plan de acción escrito), la evaluación de la terapia del asma, y la remisión a un terapeuta respiratorio y el médico de atención primaria. El objetivo principal fue determinar el efecto de este programa (iniciada por los farmacéuticos comunitarios) en el control del asma, según lo medido por el Cuestionario de Control del Asma. Los objetivos secundarios incluyeron la determinación del efecto del programa sobre el número de visitas a urgencias y los ingresos hospitalarios, el uso de corticosteroides inhalados, cursos de esteroides orales, y la función pulmonar. Los puntos finales fueron medidos al inicio del estudio, 2 meses y 6 meses. Resultados: Se asignaron al azar un total de 70 pacientes (34 con la atención habitual, de 36 años de la intervención). A los 6 meses, no hubo una diferencia significativa en el control del asma entre los grupos de atención e inter-vención habituales (ACQ cambio en la puntuación de 0,33 y 0,43 respectivamente, p = 0,66). No hubo diferencias significativas en los criterios de valoración secundarios. En general, farmacéutico cumplimiento de la intervención era pobre. CONCLUSIONES: Aunque no se encontraron diferencias en el control del asma, este modelo, que utiliza un enfoque multidisciplinario, basado en la comunidad, ofrece una estrategia de gestión único para los pacientes de asma rurales.
MÉTODOS: La prevalencia de asma en adultos en los Estados Unidos es de aproximadamente el 7% y el 9% de los pacientes de asma requerirá hospitalización cada año. Muchos pacientes no buscan atención, ya que no reconocen el uso excesivo de los beta-agonistas como un factor de riesgo para el asma mal controlada. Sin embargo, los farmacéuticos son capaces de identificar a estos pacientes a través de información recarga en recetas de medicamentos de alivio y potencialmente iniciar oportunidades de ordenación comunitarios para estos pacientes.
DISEÑO: El estudio es un ensayo aleatorizado y controlado. Los pacientes se asignaron al azar a la intervención o la atención habitual.
Población de estudio: Los pacientes son pacientes con asma de alto riesgo (definido como tener una visita a urgencias u hospitalización durante el año anterior, o el uso de> 2 botes de beta-agonistas de acción corta en los 6 meses anteriores). Ellos se identifican a través de oficinas de farmacia.
OBJETIVOS: El objetivo principal es determinar el efecto de un programa de educación y remisión intervención iniciada por los farmacéuticos comunitarios, el trabajo con pacientes de asma de alto riesgo, los médicos de familia y terapeutas respiratorios, sobre el control del asma, según lo medido por el Cuestionario de Control del Asma (ACQ) . Los objetivos secundarios incluyen determinar el efecto de este programa de visitas a urgencias / hospitalizaciones, uso de corticosteroides inhalados, cursos de esteroides orales y FEV (1).
Intervención: La intervención incluye la educación del paciente, evaluación y optimización de la terapia con medicamentos, y el médico de referencia, según sea necesario. Los pacientes son derivados a un terapeuta respiratorio dentro de 1 semana de asignación al azar para la medición del FEV (1) y el refuerzo de la educación. Los pacientes asignados a la atención habitual reciben información escrita el asma, la remisión a un terapeuta respiratorio y habitual en la farmacia y cuidado médico. Aspectos únicos: El diseño de la mejor educación respiratoria y el tratamiento del asma en Hinton y Edson (tomar aire) estudio es único, que esté en función, a los pacientes la participación multidisciplinaria, rurales y comunitarias farmacéutico iniciado y se dirige específicamente de alto riesgo. Creemos que este estudio muestran que el manejo de los pacientes con asma, la participación de los principales jugadores de rol en el cuidado del asma, mejorará su control del asma.
Asthma clinical guidelines suggest written asthma action plans are essential for improving self-management and outcomes.
OBJECTIVES:
To assess the efficacy of written instructions in the form of a written asthma action plan provided by subspecialist physicians as part of usual asthma care during office visits.
METHODS:
A total of 407 children and adults with persistent asthma receiving first-time care in pulmonary and allergy practices at 4 urban medical centers were randomized to receive either written instructions (n = 204) or no written instructions other than prescriptions (n = 203) from physicians.
MEASUREMENTS AND MAIN RESULTS:
Using written asthma action plan forms as a vehicle for providing self-management instructions did not have a significant effect on any of the primary outcomes: (1) asthma symptom frequency, (2) emergency visits, or (3) asthma quality of life from baseline to 12-month follow-up. Both groups showed similar and significant reductions in asthma symptom frequency (daytime symptoms [P < 0.0001], nocturnal symptoms [P < 0.0001], β-agonist use [P < 0.0001]). There was also a significant reduction in emergency visits for the intervention (P < 0.0001) and control (P < 0.0006) groups. There was significant improvement in asthma quality-of-life scores for adults (P < 0.0001) and pediatric caregivers (P < 0.0001).
CONCLUSIONS:
Our results suggest that using a written asthma action plan form as a vehicle for providing asthma management instructions to patients with persistent asthma who are receiving subspecialty care for the first time confers no added benefit beyond subspecialty-based medical care and education for asthma. Clinical trial registered with www.clinicaltrials.gov (NCT 00149461).
