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Randomised comparison of guided self management and traditional treatment of asthma over one year

BMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7033.748 (Published 23 March 1996) Cite this as: BMJ 1996;312:748
  1. Aarne Lahdensuo, heada,
  2. Tari Haahtela, directorb,
  3. Jaakko Herrala, consultant physiciana,
  4. Tuomo Kava, headc,
  5. Kirsti Kiviranta, consultant physicianb,
  6. Paula Kuusisto, consultant physiciana,
  7. Erkki Peramaki, consultant physician STAT-Consulting, 33300 Tamperec,
  8. Tuija Poussa, statisticianc,
  9. Seppo Saarelainen, consultant physiciana,
  10. Thore Svahn, clinical research scientistd
  1. a Department of Pulmonary Diseases, Tampere University Hospital, 36280 Pikonlinna, Finland
  2. b Skin and Allergy Hospital, Helsinki University Central Hospital, 00250 Helsinki
  3. c Department of Pulmonary Diseases, Central Hospital of Northern Karelia, 80780 Kontioniemi
  4. d Suomen Astra Oy, 02430 Masala
  1. Correspondence to: Dr Lahdensuo.
  • Accepted 13 December 1995

Abstract

Objective: To compare the efficacy of self management of asthma with traditional treatment.

Design: 12 month prospective randomised trial.

Setting: Outpatient clinics in Finland.

Subjects: 115 patients with mild to moderately severe asthma.

Interventions: Patient education and adjustment of anti-inflammatory therapy guided by peak flow measurements.

Main outcome measures: Unscheduled admissions to hospital and outpatient visits, days off work, courses of antibiotics and prednisolone, lung function, and quality of life.

Results: The mean number of unscheduled visits to ambulatory care facilities (0.5 v 1.0), days off work (2.8 v 4.8), and courses of antibiotics (0.4 v 0.9) and prednisolone (0.4 v 1.0) per patient were lower and the quality of life score (16.6 v 8.4 at 12 months) higher in the self management group than in the traditionally treated group. In both groups admissions for asthma were rare.

Conclusions: Self management reduces incidents caused by asthma and improves quality of life.

Key messages

  • Key messages

  • This trial of 115 patients with mild to moderately severe disease randomised half to a traditional care and half to a self management programme consisting of education about asthma and daily peak flow readings

  • Intervention thresholds of < 85% of the optimal peak flow for doubling the dose of inhaled steroid for two weeks and of < 70% of the optimal peak flow for starting a course of oral steroids worked well

  • The self management group had fewer incidents (consultations, days off work, courses of prednisolone or antibiotics) than the traditionally treated group and better quality of life scores

  • Adherence of patients to the self management instructions was better than expected

Footnotes

  • Funding Suomen Astra Oy.

  • Conflict of interest None.

  • Accepted 13 December 1995
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