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Am Fam Physician. 2004;70(2):378-379

Asthma affects a substantial number of persons in the United States. Treatment strategies for asthma include daily self-management that relies on acquiring and mastering specific knowledge and skills. Some of the elements of self-management are correct inhalation techniques, skills in monitoring the condition and self-assessment, and an action plan for acute exacerbations. The concept supporting self-management is that providing basic information and teaching skills to patients leads to better asthma control. Janson and associates evaluated the effects of individual self-management education on adherence to compliance with anti-inflammatory medication regimens, biological markers of airway inflammation, and clinical outcomes.

The study design was a prospective, randomized controlled trial of adults with mild to moderate persistent asthma who had just received a prescription for inhaled corticosteroids. Inclusion criteria were physician diagnosis of asthma, age between 18 and 55 years, nonsmoking status, and bronchial hyperresponsiveness to inhaled methacholine. The main exclusion criteria were recent treatment with oral corticosteroids, upper respiratory tract infection, and lung disease other than asthma.

After a one-week run-in period, participants were assigned randomly to a self-management asthma education group or a control group. The education program consisted of basic facts about asthma and instruction about the necessary skills, such as correct use of a metered-dose inhaler with a spacer and peak flow measurement. In addition, patients in the education group were provided with a simple written action plan based on peak flow measurements. All participants were assessed for adherence to inhaled corticosteroid therapy, decreased biological markers of airway inflammation, and improvement of clinical asthma control.

Of the 68 participants who met the study criteria, the self-management education group had a significant improvement in adherence to inhaled corticosteroid therapy and self-reported asthma control compared with the control group. Favorable improvement in all other clinical measurements occurred in the self-management education group compared with the control group, but none reached statistical significance. Sputum eosinophils were significantly lower in the intervention group than the control group.

The authors conclude that an individual self-management education program for patients with asthma improves adherence with inhaled corticosteroid therapy, enhances perceived control of asthma, and reduces sputum eosinophilia, an inflammatory marker. They add that while this was a short-term study, a long-term study is needed to determine whether this educational program will reduce asthma morbidity.

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