Self-management program in treatment of asthma

Abstract

INTRODUCTION: Recently published national and international guidelines stress the importance of self-management in asthma. They have recommended that self-management plans should be an essential part of the long-term management of asthmatic patients. These plans essentially focus on the early recognition of unstable or deteoriorating asthma, by monitoring peak flow or symptoms. OBJECTIVE: The aim of our one-year study was to compare the efficacy of peak-flow based self-management of asthma with traditional treatment. METHOD: Sixty clinically stable adult patients with mild and moderate persistent asthma were randomly allocated to peak-flow based self-management (Group A, n=30) or to conventional treatment (Group B, n=30), with no significant difference between groups in terms of age, sex distribution and initial lung function. The recorded measurements were: lung function, asthma exacerbations, unscheduled ambulatory care facilities (hospital-based emergency department, consultations with general practitioner or pulmonologist), courses of oral prednisolone, courses of antibiotics, days off work. RESULTS: There was a significant difference between groups in number of asthma exacerbations (p < 0.05), unscheduled visits to ambulatory care facilities (p < 0.005), days off work (p < 0.0001), courses of oral prednisolone (p < 0.001) and antibiotics (p < 0.05). At the final visit, there was a significant improvement in some measurements of asthma severity in group A (reduced unscheduled visits for ambulatory care, reduced treatment requirements for oral corticosteroids and antibiotics, reduced days off work), but a lack of statistical difference in lung function and the maintenance-inhaled corticosteroid dose. There was no significant change in group B. CONCLUSION: These results suggest that peak-flow based self-management is more effective than traditonal treatment in mild and moderate persistent asthma.