What do patients need to know about their asthma?
- Andrea J Apter, MD, MSc, MA
Andrea J Apter, MD, MSc, MA
- Professor of Medicine, Chief and Program Director
- 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 [1-10]. 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 2014 which includes a guide for patients [9,11].
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 [12,13]. 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).
- Bailey WC, Clark NM, Gotsch AR, et al. Asthma prevention. Task Force on Research and Education for the Prevention and Control of Respiratory Diseases. Chest 1992; 102:216S.
- 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.
- Kotses H, Bernstein IL, Bernstein DI, et al. A self-management program for adult asthma. Part I: Development and evaluation. J Allergy Clin Immunol 1995; 95:529.
- Wilson SR. Patient and physician behavior models related to asthma care. Med Care 1993; 31:MS49.
- National Heart Lung and Blood Institute Expert Panel Report 2. Guidelines for the diagnosis and management of asthma. National Institutes of Health, Bethesda, 1997, Pub. #97-4051.
- Centers for Disease Control and Prevention (CDC), Health Resources and Services Administration, National Institutes of Health, HIV Medicine Association of the Infectious Diseases Society of America. Incorporating HIV prevention into the medical care of persons living with HIV. Recommendations of CDC, the Health Resources and Services Administration, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep 2003; 52:1.
- Global Initiative for Asthma: You can control your asthma. http://www.ginasthma.org/Patients (Accessed on May 21, 2015).
- Pocket guide for asthma management and prevention: A pocket guide for physicians and nurses updated 2015. http://www.ginasthma.org/documents/1/Pocket-Guide-for-Asthma-Management-and-Prevention (Accessed on May 21, 2015).
- National Asthma Education and Prevention Program. National Asthma Education and Prevention Program. Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma Update on Selected Topics--2002. J Allergy Clin Immunol 2002; 110:S141.
- Global Initiative for Asthma. http://www.ginasthma.org/ (Accessed on May 21, 2015).
- 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.
- 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.
- 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.
- 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