Step 6: Educate and Review Regularly
Education is necessary to help patients gain the motivation,
skills and confidence to control their asthma.
Limited (information-only) patient education programs for adults
with asthma
Level 1 evidence from 11 randomised controlled trials of programs
that provided information about asthma and its management showed no
clinically important differences in hospitalisation, FEV1,
PEF or unscheduled visits to the doctor for asthma. Some improvement was
noted in self-reported symptoms of asthma (Gibson PG, et al, CDSR) [LEVEL
1].
Patients should be encouraged to take responsibility for their
asthma, make appropriate changes to medication when necessary and attend
for regular review.
Self-management and regular practitioner review for adults
with asthma
Optimal self-management education (i.e. the provision of
information, self-monitoring, regular medical review and the provision
of an individualised written action plan) led to clinically significant
reductions in hospitalisations, emergency room visits, and unscheduled
visits to the doctor for asthma. Statistically significant (but not
clinically significant) improvements also occurred in lung function as
measured by FEV1 and PEF. Successful completion of an optimal
self-management education program by 20 patients prevents one
hospitalisation, while completion by eight patients prevents one
emergency department visit (Gibson PG, et al, CDSR) [LEVEL
1].
Doctor-managed versus self-managed asthma for adults with asthma
In five studies, subjects who managed their own asthma using optimal
self-management (peak flow or symptoms) were compared with subjects who
regularly visited the doctor for their management. The doctors provided
periodic, structured, clinical review visits, which involved assessment
of medication use and of asthma severity based on symptoms and lung
function. Doctor-management outcomes were equivalent to self-management
education (Gibson PG, et al, CDSR) [LEVEL
1].
Education versus no education in patients presenting to the
emergency department for adults with asthma
There appears to be a reduction in repeat emergency department
visits in subjects with a higher risk of experiencing asthma attacks, if
these subjects receive any form of education (either information-only or
optimal self-management) (Gibson PG, et al, CDSR) [LEVEL
2].