Guided self management of asthma---how to do it

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Abstract
Introduction Almost 75% of admissions for asthma are avoidable, and potentially preventable factors are common in deaths from asthma.1 2 At least 40% of people with asthma do not react appropriately when their symptoms worsen, and over 50% of patients admitted with acute asthma have had alarming symptoms for at least a week before admission.3 4 As many as 60% of asthmatic patients are poor at judging their dyspnoea.5 Self management of asthma involves the patient making therapeutic, behavioural, and environmental adjustments in accordance with advice from healthcare professionals.6 Guided self management of asthma is a treatment strategy in which patients are taught to act appropriately when the first signs of asthma exacerbations appear. In a recent Cochrane review, self management of asthma in adults was compared with usual care in 22 studies.7 Self management education reduced hospital admissions (odds ratio 0.57, 95% confidence interval 0.38 to 0.88), emergency room visits (0.71, 0.57 to 0.90), unscheduled visits to the doctor (0.57, 0.40 to 0.82), days off work or off school (0.55, 0.38 to 0.79), and nocturnal asthma (0.53, 0.39 to 0.72). Self management programmes that contained a written action plan showing patients how to act in early exacerbations showed a greater reduction in admissions to hospital than did programmes without a plan (0.35, 0.18 to 0.68). Box 1: Reasons for self management of asthma Insidious deterioration (common in asthma)2 Three quarters of asthma exacerbations resulting in hospital care are preventable1 Nearly half of patients react inappropriately to asthma exacerbations3 Poor perception of deteriorating dyspnoea5 Proved value of patient education in the treatment of asthma10 Poor compliance (30-40%) with asthma drugs11 RETURN TO TEXT Cost effectiveness studies of self management programmes for asthma have shown positive results, with cost benefit ratios between 1:2.5 and 1:11.228; the programme with the most favourable result saved $11.22 (£7) for every $1 (£1.60) spent. Summary points Self management of asthma prevents exacerbations, improves care, and is a cost effective investment Patient education is crucial and should be given in a structured way Patients should be taught to understand their symptoms and to monitor peak expiratory flow at home Patients should know how to act when signs of asthma deterioriation first appear There should always be supervision of and continuity in asthma care