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Benefit from the inclusion of self-treatment guidelines to a self-management programme for adults with asthma

¹ Dept of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, ² Depts of Pulmonary Medicine and ³ Epidemiology, Dekkerswald, University of Nijmegen and ⁴ Dept of Psychology, University of Twente, Enschede, the Netherlands

CORRESPONDENCE: J.J. Klein, Medisch Spectrum Twente, Afdeling Longziekten, Postbus 50000, 7500 KA, Enschede, the Netherlands. Fax: 31 0 534872638

Keywords: asthma, patient education, self-management, self-treatment

Received: February 3, 2000
Accepted September 19, 2000

This study was funded by the Netherlands Asthma Foundation (Grant 94-52), GlaxoWellcome, the "Stichting Astmabestrijding", and Amicon Health Care Insurance Fund.

This study assessed the long-term efficacy of adding self-treatment guidelines to a self-management programme for adults with asthma.

In this prospective randomized controlled trial, 245 patients with stable, moderate to severe asthma were included. They were randomized into a self-treatment group (group S) and a control group (group C). Both groups received self-management education. Additionally, group S received self-treatment guidelines based on peak expiratory flow (PEF) and symptoms. Outcome parameters included: asthma symptoms, quality of life, pulmonary function, and exacerbation rate. The 2-yr study was completed by 174 patients.

Both groups showed an improvement in the quality of life of 7%. PEF variability decreased by 32% and 29%, and the number of outpatient visits by 25% and 18% in groups S and C, respectively. No significant differences in these parameters were found between the two groups. After 1 yr, patients in both groups perceived better control of asthma and had more self-confidence regarding their asthma. The latter improvements were significantly greater in group S as compared to group C. There were no other differences in outcome parameters between the groups.

Individual self-treatment guidelines for exacerbations on top of a general self-management programme does not seem to be of additional benefit in terms of improvements in the clinical outcome of asthma. However, patients in the self-treatment group had better scores in subjective outcome measures such as perceived control of asthma and self-confidence than patients in the control group.

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