Clinical Review

Guided self management of asthma—how to do it

BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7212.759 (Published 18 September 1999) Cite this as: BMJ 1999;319:759
  1. Aarne Lahdensuo, head (aarne.lahdensuo@tays.fi)
  1. Department of Pulmonary Diseases, Tampere University Hospital, 36280 Pikonlinna, Finland

    Introduction

    Almost 75% of admissions for asthma are avoidable, and potentially preventable factors are common in deaths from asthma.1 2 At least 40% of people with asthma do not react appropriately when their symptoms worsen, and over 50% of patients admitted with acute asthma have had alarming symptoms for at least a week before admission.3 4 As many as 60% of asthmatic patients are poor at judging their dyspnoea.5 Self management of asthma involves the patient making therapeutic, behavioural, and environmental adjustments in accordance with advice from healthcare professionals.6 Guided self management of asthma is a treatment strategy in which patients are taught to act appropriately when the first signs of asthma exacerbations appear.

    In a recent Cochrane review, self management of asthma in adults was compared with usual care in 22 studies.7 Self management education reduced hospital admissions (odds ratio 0.57, 95% confidence interval 0.38 to 0.88), emergency room visits (0.71, 0.57 to 0.90), unscheduled visits to the doctor (0.57, 0.40 to 0.82), days off work or off school (0.55, 0.38 to 0.79), and nocturnal asthma (0.53, 0.39 to 0.72). Self management programmes that contained a written action plan showing patients how to act in early exacerbations showed a greater reduction in admissions to hospital than did programmes without a plan (0.35, 0.18 to 0.68).

    Box 1: Reasons for self management of asthma

    • Insidious deterioration (common in asthma)2

    • Three quarters of asthma exacerbations resulting in …

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