Asthma morbidity 6 yrs after an effective asthma self-management programme in a Maori community

A 6-month Maori community-based asthma self-management programme, involving a "credit card" asthma self-management plan, has previously been shown to be an effective and acceptable system for reducing asthma morbidity. The effectiveness of the asthma self-management programme and participants' self-management behaviour was assessed 6 yrs after the formal end of the programme. Participants were surveyed at the time of enrollment, and 1, 2, and 6 yrs after completing the programme. In each survey, participants were questioned on markers of asthma morbidity and use of medical services during the previous 12 months. Self-management behaviour was assessed using a questionnaire at 2 years and 6 yrs. Of the 69 original participants, 47 (68%) were surveyed after 6 yrs. They generally had reduced severe asthma morbidity and emergency use of health services from baseline. In particular, the proportion who had an emergency visit to a general practitioner had decreased from 41% to 18% (p=0.02). However, the percentage of nights woken due to asthma had returned to preintervention levels, and the proportion of participants taking prescribed regular inhaled steroid had decreased from 91% to 53% (p<0.001). Compared with 2 yrs after completion of the asthma programme, self-management behaviour had also deteriorated, with 29% versus 73% (p<0.001) using their peak flow meter daily when their asthma was "getting bad" and 41% versus 86% (p<0.001) using the "credit card" plan to increase the amount of inhaled steroids in the last year. Although the programme participants were still experiencing reduced morbidity from their asthma 6 yrs after the end of the self-management programme, the benefits were less than those observed at 2 yrs. These findings suggest that under-recognition and under-treatment of asthma with appropriate amounts of inhaled steroids is a major factor contributing to asthma morbidity in this indigenous rural community. To obtain enduring benefits from a self-management system of care continued reinforcement of self-management skills seems to be an essential component of any follow-up.

This article has been cited by other articles:

				C. Put, O. van den Bergh, V. Lemaigre, M. Demedts, and G. Verleden Evaluation of an individualised asthma programme directed at behavioural change Eur. Respir. J., January 1, 2003; 21(1): 109 - 115. [Abstract] [Full Text] [PDF]

				J-M. Ignacio-Garcia, M. Pinto-Tenorio, M.J. Chocron-Giraldez, F. Cabello-Rueda, A.I. Lopez-Cozar Gil, J-M. Ignacio-Garcia, and E. de Ramon-Garrido Benefits at 3 yrs of an asthma education programme coupled with regular reinforcement Eur. Respir. J., November 1, 2002; 20(5): 1095 - 1101. [Abstract] [Full Text] [PDF]