Options for self-management education for adults with asthma

 

Abstract

Background

Asthma education and self-management are key recommendations of asthma management guidelines because they improve health outcomes. There are several different modalities for the delivery of asthma self-management education.

Objectives

We evaluated programmes that:
(1) Optimised asthma control through inhaled corticosteroid use by regular medical review or optimised asthma control by individualised written action plans;
(2) Used written self-management plans based on peak expiratory flow self-monitoring compared with symptom self-monitoring;
(3) Compared different options for the delivery of optimal self-management programmes.

Search methods

We searched the Cochrane Airways Group trials register and reference lists of articles.

Selection criteria

Randomised trials of asthma self-management education interventions in adults over 16 years of age with asthma.

Data collection and analysis

Fifteen trials met the inclusion criteria. Trial quality was assessed and data were extracted independently by two reviewers. Study authors were contacted for confirmation.

Main results

Six studies compared optimal self-management allowing self-adjustment of medications according to an individualised written action plan to adjustment of medications by a doctor. These two styles of asthma management gave equivalent effects for hospitalisation, emergency room (ER) visits, unscheduled doctor visits and nocturnal asthma. Self-management using a written action plan based on peak expiratory flow (PEF) was found to be equivalent to self-management using a symptoms based written action plan in the six studies which compared these interventions. Three studies compared self-management options. In one, that provided optimal therapy but tested the omission of regular review, the latter was associated with more health centre visits and sickness days. In another, comparing high and low intensity education, the latter was associated with more unscheduled doctor visits. In a third, no difference in health care utilisation or lung function was reported between verbal instruction and written action plans.

Authors' conclusions

Optimal self-management allowing for optimisation of asthma control by adjustment of medications may be conducted by either self-adjustment with the aid of a written action plan or by regular medical review. Individualised written action plans based on PEF are equivalent to action plans based on symptoms. Reducing the intensity of self-management education or level of clinical review may reduce its effectiveness.

 

Plain language summary

Options for self-management education for adults with asthma

Guidelines for the treatment of asthma recommend that patients be educated about their condition, obtain regular medical review, monitor their condition at home with either peak flow or symptoms and use a written action plan. This is known to improve health outcomes when compared to usual medical care. A number of variations on optimal self-management have now been described. This review examines the efficacy of some of these options. The results showed that self-adjustment of medications according to a written action plan gave a similar improvement in health outcomes to adjustment of medications by a doctor. Either symptom diaries or peak expiratory flow monitoring may be used for monitoring asthma and reducing the intensity of the education appears to dilute the effect.

 

摘要

背景

成人氣喘自行處置教育的選項

由於氣喘教育及自行處置能改善健康狀況而成為氣喘處置指引的主要建議。氣喘自行處置教育的執行有幾種不同的方式。

目標

我們評估下列計畫：(1)以定期看診或個人化之書面改善計畫調節吸入式皮質類固醇以獲得最佳氣喘控制；(2)比較基於最大呼氣流量的自行監測及症狀自行監測之書面自行處置計畫；(3)比較最佳自行控制計畫的不同選項。

搜尋策略

我們搜尋Cochrane Airways Group trials register及文章的參考文獻。

選擇標準

針對16歲以上氣喘成人患者的氣喘自行處置教育介入的隨機試驗。

資料收集與分析

有15項試驗符合納入標準。試驗品質的評估及數據的摘錄由兩名審查者獨立執行。亦會聯絡研究作者來確認資料。

主要結論

(1)有六項研究比較依個人化書面改善計畫所容許的自行調節藥物與醫師調節用藥來達成最佳自行處置。此兩種處置氣喘的方式在住院、急診、未經預約的看診及夜間氣喘等指標均能提供同等效益。(2)有六項研究比較基於最大呼氣流量(PEF)的書面改善計畫的自行處置與基於症狀的書面改善計畫的自行處置效果相當；(3)有三項研究比較自行處置的選項。其中一項提供最佳治療並檢測定期診察的遺漏，後者有伴隨較多到健康中心看診及生病的日子。另一項研究比較高、低不同程度的教育，後者有伴隨較多的非排程看診。第三篇則顯示口述說明與書面改進計畫在醫療照護的利用及肺功能等並無差異。

作者結論

藉由書面改進計畫之自行調節或以規律的醫療診察進行藥物調節均可獲得最佳的氣喘控制。基於PEF的個人化書面改善計畫與基於症狀的改善計畫具同等效力。降低自行處置教育的課程程度或臨床診察的深刻程度會降低其效力。

翻譯人

本摘要由中國醫藥大學附設醫院陳祖裕翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

氣喘治療指引推薦教育病人了解自己的狀況、有定期的醫療診察、以最大流量或症狀來監測在家的情況，以及書面改進計畫等。這些方法已知較一般醫療照護更能改善醫療照護的結果。最佳自行處置被描述有一些變異。本回顧檢視其中一些項目的效果。結果顯示依照書面改進計畫自行調節藥物與醫師調節藥在改善健康結果的效果相近。症狀日誌或最大呼氣流量監測可用作監測氣喘，而降低教育課程程度則顯然會淡化其效果。