What do patients need to know about their asthma?
- Andrea J Apter, MD, MSc, MA
Andrea J Apter, MD, MSc, MA
- Professor of Medicine
- Section of Allergy & Immunology, Division of Pulmonary, Allergy, Critical Care Medicine
- Perelman School of Medicine, University of Pennsylvania
- Section Editors
- Bruce S Bochner, MD
Bruce S Bochner, MD
- Editor-in-Chief — Allergy and Immunology
- Section Editor — Adult Allergy; Asthma
- Samuel M Feinberg Professor of Medicine
- Northwestern University Feinberg School of Medicine
- Robert A Wood, MD
Robert A Wood, MD
- Editor-in-Chief — Allergy and Immunology
- Section Editor — Pediatric Allergy
- Professor of Pediatrics
- Johns Hopkins University School of Medicine
There are a number of publications that describe what patients need to know about their asthma [1-3]. Perhaps the most important and far-reaching document on what to include in an asthma education program has been "the National Asthma Education and Prevention Program: Expert Panel Report 3, Guidelines for the Diagnosis and Management of Asthma -- Full Report 2007" . The full text is available at the website of the National Heart, Lung, and Blood Institute . The Global Initiative for Asthma updated their guidelines in 2016 [2,3].
A comprehensive asthma education program covering all asthma education topics in depth may not be possible in all clinical settings. Based on a series of focus group interviews, the "core elements" necessary in an asthma education program have been identified [4,5]. The three topics of primary importance for patient education are the following:
●Function and appropriate use of medication
●Pathophysiology of asthma
●Issues in the prevention and treatment of symptoms
- National Asthma Education and Prevention Program: Expert panel report III: Guidelines for the diagnosis and management of asthma. Bethesda, MD: National Heart, Lung, and Blood Institute, 2007. (NIH publication no. 08-4051) www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm (Accessed on December 04, 2014).
- Pocket guide for asthma management and prevention: A pocket guide for health professionals: Updated 2017 http://www.ginasthma.org/documents/1/Pocket-Guide-for-Asthma-Management-and-Prevention (Accessed on April 17, 2017).
- Global Initiative for Asthma. GINA Report 2017, Global Strategy for Asthma Management and Prevention. http://www.ginasthma.org/ (Accessed on May 09, 2017).
- Bailey WC, Richards JM Jr, Brooks CM, et al. A randomized trial to improve self-management practices of adults with asthma. Arch Intern Med 1990; 150:1664.
- Kohler CL, Dolce JJ, Manzella BA, et al. Use of focus group methodology to develop an asthma self-management program useful for community-based medical practices. Health Educ Q 1993; 20:421.
- Pinnock H, Parke HL, Panagioti M, et al. Systematic meta-review of supported self-management for asthma: a healthcare perspective. BMC Med 2017; 15:64.
- Bartholomew LK, Gold RS, Parcel GS, et al. Watch, Discover, Think, and Act: evaluation of computer-assisted instruction to improve asthma self-management in inner-city children. Patient Educ Couns 2000; 39:269.
- Cicutto L, Murphy S, Coutts D, et al. Breaking the access barrier: evaluating an asthma center's efforts to provide education to children with asthma in schools. Chest 2005; 128:1928.
- Cordina M, McElnay JC, Hughes CM. Assessment of a community pharmacy-based program for patients with asthma. Pharmacotherapy 2001; 21:1196.
- Gibson PG, Powell H, Coughlan J, et al. Self-management education and regular practitioner review for adults with asthma. Cochrane Database Syst Rev 2003; :CD001117.
- Gibson PG, Powell H, Coughlan J, et al. Limited (information only) patient education programs for adults with asthma. Cochrane Database Syst Rev 2002; :CD001005.
- Guevara JP, Wolf FM, Grum CM, Clark NM. Effects of educational interventions for self management of asthma in children and adolescents: systematic review and meta-analysis. BMJ 2003; 326:1308.
- Krishna S, Francisco BD, Balas EA, et al. Internet-enabled interactive multimedia asthma education program: a randomized trial. Pediatrics 2003; 111:503.
- Powell H, Gibson PG. Options for self-management education for adults with asthma. Cochrane Database Syst Rev 2003; :CD004107.
- Wesseldine LJ, McCarthy P, Silverman M. Structured discharge procedure for children admitted to hospital with acute asthma: a randomised controlled trial of nursing practice. Arch Dis Child 1999; 80:110.
- Bonner S, Zimmerman BJ, Evans D, et al. An individualized intervention to improve asthma management among urban Latino and African-American families. J Asthma 2002; 39:167.
- Christiansen SC, Martin SB, Schleicher NC, et al. Evaluation of a school-based asthma education program for inner-city children. J Allergy Clin Immunol 1997; 100:613.
- Clark NM, Brown R, Joseph CL, et al. Effects of a comprehensive school-based asthma program on symptoms, parent management, grades, and absenteeism. Chest 2004; 125:1674.
- Janson SL, Fahy JV, Covington JK, et al. Effects of individual self-management education on clinical, biological, and adherence outcomes in asthma. Am J Med 2003; 115:620.
- Wilson SR, Strub P, Buist AS, et al. Shared treatment decision making improves adherence and outcomes in poorly controlled asthma. Am J Respir Crit Care Med 2010; 181:566.
- Apter AJ, Wan F, Reisine S, et al. The association of health literacy with adherence and outcomes in moderate-severe asthma. J Allergy Clin Immunol 2013; 132:321.
- Lemanske RF Jr, Kakumanu S, Shanovich K, et al. Creation and implementation of SAMPRO™: A school-based asthma management program. J Allergy Clin Immunol 2016; 138:711.
- Yin HS, Gupta RS, Tomopoulos S, et al. Readability, suitability, and characteristics of asthma action plans: examination of factors that may impair understanding. Pediatrics 2013; 131:e116.
- Dinakar C, Oppenheimer J, Portnoy J, et al. Management of acute loss of asthma control in the yellow zone: a practice parameter. Ann Allergy Asthma Immunol 2014; 113:143.
- Clark NM, Gotsch A, Rosenstock IR. Patient, professional, and public education on behavioral aspects of asthma: a review of strategies for change and needed research. J Asthma 1993; 30:241.
- Wilson SR. Patient and physician behavior models related to asthma care. Med Care 1993; 31:MS49.
- Kohler CL, Davies SL, Bailey WC. How to implement an asthma education program. Clin Chest Med 1995; 16:557.
- EFFECTIVENESS OF EDUCATION
- ESTABLISHING A PARTNERSHIP
- ASTHMA ACTION PLANS
- Daily asthma care
- Attack management
- - Detecting symptoms and initiating treatment
- - Indications for emergency care
- PATIENT EDUCATION
- Understanding asthma
- - What is asthma?
- - Characteristic airway changes
- - Treatment
- - Patient fears concerning medication
- - Proper health care resource utilization
- Attack prevention
- - Signs and symptoms of asthma
- - Role of medications
- - Factors that make asthma worse
- - Correct inhaler use
- - Monitoring
- - Premedicating to prevent onset of symptoms
- - Evaluation of results of treatment plan
- - Fears and misconceptions
- - Family support
- - Feelings about asthma
- - Communication with the health care team
- - Communication with the child's school
- - Health promotion behaviors
- INCORPORATING ASTHMA EDUCATION INTO PATIENT VISITS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS