Individualized asthma self-management improves medication adherence and markers of asthma control
| Autor: | Susan L. Janson, Kelly Wong McGrath, Jack K. Covington, Homer A. Boushey, Su-Chun Cheng |
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| Rok vydání: | 2009 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.drug_class Immunology Article Medication Adherence law.invention Pulmonary function testing Randomized controlled trial law Forced Expiratory Volume Internal medicine Intervention (counseling) medicine Humans Immunology and Allergy Asthma Self-management business.industry Inhaler Odds ratio Middle Aged medicine.disease Self Care Physical therapy Corticosteroid Female business |
| Zdroj: | Journal of Allergy and Clinical Immunology. 123:840-846 |
| ISSN: | 0091-6749 |
| Popis: | Background Adherence to inhaled anti-inflammatory therapy and self-management skills are essential parts of the asthma treatment plan to improve asthma control and prevent exacerbations. Whether self-management education improves long-term medication adherence is less clear. Objective A 24-week prospective, randomized controlled trial was performed to study the effect of self-management education on long-term adherence to inhaled corticosteroid (ICS) therapy and markers of asthma control. Methods After stabilization on ICS medication during a run-in phase, 95 adults with moderate-to-severe asthma were recruited from a large metropolitan community, and 84 were randomized to individualized self-management education, including self-monitoring of symptoms and peak flow or usual care with self-monitoring alone. The key components of the 30-minute intervention were asthma information, assessment, and correction of inhaler technique; an individualized action plan based on self-monitoring data; and environmental control strategies for relevant allergen and irritant exposures. The intervention was personalized based on pulmonary function, allergen skin test reactivity, and inhaler technique and reinforced at 2-week intervals. Results Participants randomized to the self-management intervention maintained consistently higher ICS adherence levels and showed a 9-fold greater odds of more than 60% adherence to the prescribed dose compared with control subjects at the end of the intervention ( P = .02) and maintained a 3-fold greater odds of higher than 60% adherence at the end of the study. Perceived control of asthma improved ( P = .006), nighttime awakenings decreased ( P = .03), and inhaled β-agonist use decreased ( P = .01) in intervention participants compared with control subjects. Conclusion Our results show that individualized asthma self-management education attenuates the usual decrease in medication adherence and improves clinical markers of asthma control. |
| Databáze: | OpenAIRE |
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