Role of the Subspecialist
Leadership in the use, dissemination, refinement, and adaptation of the available self-management education programs rests with the cardiopulmonology, allergy, and immunology communities. This leadership will take several forms. First, practitioners can adapt existing programs for use in their private practices or encourage the adoption of programs by the institutions with which they collaborate. Second, practitioners can introduce the idea of self-management tasks, as identified in the studies discussed here, into their ongoing counseling of patients and family members.

Third, physicians can encourage local and regional medical and voluntary organizations to sponsor education for general practitioners, patients, families and the general public regarding the need for asthma selfmanagement and up-to-date, on-going medical care. Fourth, the practicing community can identify and communicate to their colleagues in academic research aspects of asthma self-management deserving of further study. Finally, teachers in academic medicine can influence physicians in training to adopt and adapt education and counseling related to asthma self-management as they prepare for and enter their subspecialties. Participation by the subspecialist is fundamental to engender significant changes in the dismaying statistics regarding asthma morbidity and mortality. comments

Areas of Needed Investigation
While considerable progress has been made in a relatively short period of time in furthering the efficacy of self-management education for patients with asthma, there are several overlooked areas or new areas of inquiry deserving attention. Some of the next steps in asthma education research undoubtedly will include design and implementation of programs for specific populations, for example, very young children and hard-to-reach groups; investigation of physician-patient interactions most conducive to adequate asthma self-management; design and evaluation of programs based on developing behavioral science theories; and identification of ways to disseminate more efficient and effective models of education to the medical community and to patients and families with asthma.