Efficacy of a self-management program for childhood asthma–: A prospective controlled study

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Abstract

Asthma training programs for parents and children have been developed to increase both the self-management skills of asthmatic children and compliance with medical regimes. In order to evaluate two training programs for asthmatic children aged 7–14, 81 patients were randomly assigned to three groups. Group 1 consisted of 27 patients and their parents who participated in a five-day standardized family-oriented clinical asthma training program. They had monthly follow-up meetings with the training team for a period of six months. Group 2 (n=29) had the same clinical training without follow-up interventions; a control group (n=25) received regular medical treatment according to the international guidelines at the asthma clinics without a training program and served as control group. Questionnaires regarding self-management aspects, coping and anxiety were filled out by patients, parents, family doctors and the training team prior to as well as twelve months after the training. The results indicate that Training group 1 benefitted most with respect to active asthma self-management, Training group 2 to some degree while the control group showed no significant effects. The differences after one year between the three groups regarding physical parameters such as lung-function and days missed in school did not reach the level of significance. Our results indicate that the long-term efficacy of self management courses for asthmatic children is enhanced by regular follow-up training sessions.

Introduction

Increasing prevalence of bronchial asthma in children is reported in many countries [1]. Despite increasing knowledge about the pathogenesis of asthma and a better understanding of therapeutic approaches, hospitalisation and school absenteeism due to asthma are still high 2, 3partly due to poor adherence to medical advice. Studies have shown that only about 50% of patients follow regular preventive therapies as advised by their doctors 4, 5, 6. Comparing various studies on compliance with medication regimes in children with asthma, Creer found the average compliance rate to be 43% with a wide range of 2% to 100% [7]. Treatment for and coping with asthma are based on certain patient skills which can be learnt and taught:

  • 1.

    Knowledge of prevention strategies;

  • 2.

    Knowledge of emergency measures;

  • 3.

    Early awareness of warning signs of shortness of breath;

  • 4.

    Self-monitoring of lung function.

Asthma training programs for parents and children have thus been developed to increase both the self-management skills of asthmatic children and compliance with medical regimes [8]. Recently established German programs aim to increase the coping abilities of patients and families 9, 10, 19. Asthma prevention strategies and self-monitoring were assumed to help decrease the patientś dependency on their families and physicians. Groups of six asthmatic children aged 7–14 were invited to take part in a one-week training course at the clinic. At least one parent of each child was urged to attend the parallel parents' seminar.

Only a limited number of controlled prospective studies evaluating the long-term efficacy of asthma self management programs have been conducted 11, 12, 20, 21. Since none of these studies evaluated a follow-up teaching design for children (Mesters et al. use a somewhat similar design, although they limit themselves to teaching parents of asthmatic children aged 0 to 4), our study addressed the following questions:

  • 1.

    What are the long-term effects of asthma training in addition to good clinical treatment?

  • 2.

    Are these effects increased if the training is followed by individual follow-up visits in the family?

Section snippets

Patients and methods

81 children aged 7–14 years (median age 9 years) were recruited from our outpatient clinics. An obligatory inclusion criterium was the use of preventive medication prior to our study. During the study, the mode and dosage of preventive pharmacotherapy was kept constant. Patients were assigned to two groups (Training Group 1: n=27, Training Group 2: n=29). There were no statistically relevant differences between the two groups in terms of age, sex, duration or severity of asthma (5% had mild,

Results

The results obtained from the questionnaires were evaluated separately for children, parents and family physicians:

Discussion

The effectiveness of patient education in asthmatic school children regarding knowledge has already been demonstrated by other studies [22]. Our main objective was to find out if our educational program would give the children greater responsibility in everyday asthma self management. With our interventions we hoped to ease the everyday preventive routine in the families. The group size of 25 requires relatively strong effects to reach the level of significance. Since the data was obtained from

Acknowledgements

This study was supported by a grant from the Robert Bosch Foundation, Stuttgart, Germany.

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