More information is needed on what patients think about such management

EDITOR—Lahdensuo writes in favour of guided self management plans in patients with asthma and indicates what skills patients might acquire and who may be suitable.1 However, the evidence cited from a recent Cochrane review showing a reduction in morbidity with the use of such plans2 does not convince us of their widespread application to general practice.

The trials in the review were heterogeneous, recruiting patients from hospital clinics after inpatient or emergency room attendance, from general practice, and from advertisements in newspapers and on radio seeking participants. Selection biases may be present—for example, three British trials …