Asthma Self-Management Education: Implications for PracticeIn one way or another, each of these self-management programs stresses the need for a regular systematic approach to care of patients with asthma including the consistent use of medication as prescribed by the physician, the need to avoid triggers of asthma when these are known, and to initiate early drug therapy when this is not possible. These activities, together with effective communication with physicians, facilitate what has been referred to here as a partnership between the patient (and family) and the physician. The growing appreciation that a variety of mediators involved in chronic airway inflammation play an important role in the genesis of the disease has redirected medical attention towards regimens that suppress or reverse airway inflammation. Health education programs in self-management, by stressing adherence to these regimens, should be a great help in the implementation of physician recommendations. website

We have in hand findings from several large carefully controlled research efforts, especially related to asthma in children, assessing the effectiveness of selfmanagement education. These studies provide practitioners and teachers with models for effective intervention with asthma patients. Several programs which have been evaluated with small numbers of patients or with less rigorous evaluation designs have also been reported in the literature.
Self-management education programs have been designed for use in a variety of settings: outpatient medical facilities, schools, and homes. Evaluated programs have been conducted for families at differing economic levels, and of different ethnic groups. Just over one half of the available programs are designed for use with groups of patients and their relatives and just under one half are based on individualized instruction. At least one program is available in English and Spanish. Table 1 describes characteristics and outcomes of the eight large-scale, rigorously evaluated, self-management studies. Table 2 lists six other innovative programs with less rigorous evaluations.
Table 1—Large-Scale Asthma Self-Management Programs With Rigorous Evaluation

Program Evaluator Sponsor Setting Format Pktient Outcomes
Asthma care training Lewis et al NIAID Outpatientclinic Group Child Improved self-management behavior Changes in health care use
Air power Wilson-Pessano et al NHLBI Outpatientclinic Group Child Improved self-management behavior
Open air ways Clark et al NHLBI Outpatientclinic Group Child Improved self-management behavior Changes in health care use
Open air ways at school Evans et al NHLBI School Group Childt Improved school performance Reduced anxiety associated with asthma Reductions in wheezing episodes
Living with asthma Creer et al NHLBI Outpatientclinic Group Child Improved school attendance Reductions in wheezing episodes Increased use of peak flow meters
Family asthma program Hindi-Alexander and Cropp ALA of Western NY Outpatientclinic Group Child Improved school attendance Increased physical activity
Teaching myself about asthma Parcel et al2* Health Education Associates School and home Group and individual Child Increased feelings of control over illness
Self treatment by adult asthmatics Mai man et al Emergencyroom Individual Adult Changes in health care use

Table 2—Other Self-Management Education Programs

Program Evaluator Sponsor Setting Format Patient
Use of aerosols Heringa et al* Outpatient clinic Individual Adult
Superstuff Weiss* ALA Home Individual Child
Air wise McNabb et al* NHLBI Outpatient clinic Individual Child
Asthma command Rubin et al Albert Einstein College of Medicine Home Individual-computer Child
You can control asthma Taggert et al** NIAID Outpatient clinic Group Child
Health belief model Jones et al Case Western Reserve Emergency room Individual Adult