Effects of individual self-management education on clinical, biological, and adherence outcomes in asthma

被引:63
作者
Janson, SL
Fahy, JV
Covington, JK
Paul, SM
Gold, WM
Boushey, HA
机构
[1] Univ Calif San Francisco, Dept Community Hlth Syst, Sch Nursing, San Francisco, CA 94143 USA
[2] Univ Calif San Francisco, Sch Nursing, Dept Med, San Francisco, CA 94143 USA
[3] Univ Calif San Francisco, Sch Nursing, Div Pulm & Crit Care Med, San Francisco, CA 94143 USA
[4] Univ Calif San Francisco, Div Pulm & Crit Care Med, Sch Nursing, San Francisco, CA 94143 USA
[5] Univ Calif San Francisco, Res Off, Sch Nursing, San Francisco, CA 94143 USA
关键词
D O I
10.1016/j.amjmed.2003.07.008
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND: Asthma guidelines urge teaching patients the knowledge and skills required for self-management, based on the assumption that education will lead to improved skills and better asthma control. METHODS: In a prospective, randomized controlled trial of 65 adults with mild-to-moderate asthma, we examined whether an educational self-management intervention would improve adherence to inhaled corticosteroid therapy, decrease markers of airway inflammation, and improve clinical control. Peak flow, symptoms, and adherence were monitored for 7 weeks. After a 1-week run-in, subjects were assigned randomly to either the educational intervention or control group. The 30-minute intervention was delivered and reinforced at biweekly intervals. RESULTS: Compared with the control group, the intervention group had improvements in adherence to inhaled corticosteroid therapy (by 30% vs. -5%, P = 0.01), self-reported control of asthma (by 14% vs. 5%, P = 0.04), and perhaps quality of life (by 37% vs. 21%, P = 0.06). The direction of change for all other clinical outcomes was more favorable in the intervention group, but not significantly so. Markers of inflammation in sputum decreased more in the intervention group, with sputum eosinophils declining significantly (P = 0.02). CONCLUSION: In asthmatic patients treated with inhaled corticosteroids, education and training in self-management improves adherence with inhaled therapy, perceived control of asthma, and sputum eosinophilia. (C)2003 by Excerpta Medica Inc.
引用
收藏
页码:620 / 626
页数:7
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