Randomised comparison of guided self management and traditional treatment of asthma over one year

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Abstract
Objective: To compare the efficacy of self management of asthma with traditional treatment. Design: 12 month prospective randomised trial. Setting: Outpatient clinics in Finland. Subjects: 115 patients with mild to moderately severe asthma. Interventions: Patient education and adjustment of anti-inflammatory therapy guided by peak flow measurements. Main outcome measures: Unscheduled admissions to hospital and outpatient visits, days off work, courses of antibiotics and prednisolone, lung function, and quality of life. Results: The mean number of unscheduled visits to ambulatory care facilities (0.5 v 1.0), days off work (2.8 v 4.8), and courses of antibiotics (0.4 v 0.9) and prednisolone (0.4 v 1.0) per patient were lower and the quality of life score (16.6 v 8.4 at 12 months) higher in the self management group than in the traditionally treated group. In both groups admissions for asthma were rare. Conclusions: Self management reduces incidents caused by asthma and improves quality of life. Key messages This trial of 115 patients with mild to moderately severe disease randomised half to a traditional care and half to a self management programme consisting of education about asthma and daily peak flow readings Intervention thresholds of < 85% of the optimal peak flow for doubling the dose of inhaled steroid for two weeks and of < 70% of the optimal peak flow for starting a course of oral steroids worked well The self management group had fewer incidents (consultations, days off work, courses of prednisolone or antibiotics) than the traditionally treated group and better quality of life scores Adherence of patients to the self management instructions was better than expected