Asthma: guided self management

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Abstract
Asthma is common in western Europe, and in Britain nearly three million people have the condition.1 Most medical management is provided within primary care, and guidelines are now available for its management.2,3 Although some doctors are sceptical of their value, evidence shows that if guidelines are adapted for local use they can improve some outcome measures.4,5 At the very least they are useful for educating patients and health professionals and provide a “common language” for discussing the condition. Nearly all of these guidelines mention the value of partnerships between the patient (or parent) and health professional and extol the virtues of written advice to patients and the use of (guided) self management plans. What is meant by such terms, what is the justification for their use, how do we issue advice and plans, and do they work? All patients with asthma deserve both oral and written advice about signs that their asthma may be worsening and what to do. For example, patients should be advised that waking at night with asthma, or using more doses of bronchodilators, implies poor control of their condition, and this advice can be given on simple information cards on which details of regular treatment may also be written. This may be all that some people require. (Such cards are available free from the National Asthma Campaign, Providence Place, London N1 0NT.) Other patients may require written advice about specific short term changes in treatment, and supplementing oral advice with written instructions about a series of changes in treatment greatly increases compliance.6 For other people, taking control of their own asthma (or the asthma of their child) requires a more detailed self management plan. …