Efficacy of a self-management program for childhood asthma–: A prospective controlled study
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.
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.
References (25)
- et al.
Does urinary salbutamol reflect compliance with aerosol regimes in patients with asthma?
Respir Med
(1989) - et al.
Evaluation of a family asthma program
J Allergy Clin Immunol
(1984) - et al.
The effect of health beliefs and feelings of self efficacy on self management behaviour of children with a chronic disease
Patient Educ Couns
(1988) - et al.
Self-management teaching programs and morbidity of pediatric asthma: A meta analysis
J Allergy Clin Immunol
(1995) Asthma education. A time for reappraisal
Chest
(1995)- et al.
Respiratory symptoms and atopy in Aberdeen schoolchildren: evidence from two surveys 25 years apart
Br Med J
(1992) Fatal asthma
New Eng J Med
(1986)Has the prevalence of asthma increased in children?
Br Med J
(1990)- et al.
Metered-dose inhaler adherence in a clinical trial
Am Rev Respir Dis
(1992) - et al.
Compliance of patients with asthma with an aerosolized medication. Implications for controlled clinical trials
J Allergy Clin Immunol
(1986)
Patient, professional, and public education on behavioural aspects of asthma: a review of strategies for change and needed research
J Asthma
Cited by (51)
Development and evaluation of a generic education program for chronic diseases in childhood
2017, Patient Education and CounselingCitation Excerpt :More comprehensive long-term data including data on objective indicators are needed. Studies on comparable educational programs, however, have indicated positive effects on somatic and psychosocial parameters after a follow-up period of one year [53–55]. Additionally, a control group that did not receive a training program was not included.
Addressing behavioral impacts of childhood leukemia: A feasibility pilot randomized controlled trial of a group videoconferencing parenting intervention
2016, European Journal of Oncology NursingCitation Excerpt :In one reported study, Fedele et al. (Fedele et al., 2013) delivered a cognitive behavioral intervention to parents, targeting parent mental health, in a pediatric oncology population and demonstrated improved child emotional and behavioral functioning. Similarly parenting interventions have been successful in other chronically ill pediatric populations (Morawska et al., 2015), with results indicating improved child behavior (Antonini et al., 2012; Bartholomew et al., 1997; Brown et al., 1995; Fedele et al., 2013; Hanzlik, 1989), and reduced anxiety symptoms (Chiang et al., 2009; Gebert et al., 1998; Wade et al., 2006). Qualitative research has demonstrated that assistance with parenting and child behaviors are not a key priority for parents soon after their child's diagnosis (Williams and McCarthy, 2015), and optimal timing for interventions in a pediatric oncology setting warrants empirical attention (Stehl et al., 2009).
Inpatient paediatric rehabilitation in chronic respiratory disorders
2012, Paediatric Respiratory ReviewsCitation Excerpt :Inpatient rehabilitation programs have integrated parts or whole protocols of national or regional asthma education programs, resulting in standardized en-bloc interventions. In some countries, such as Germany, asthma education programs have been standardized on a national level and are financed by the health insurances, and rehabilitation centres participate next to outpatient centres in the nation-wide educational program.11 The goals of asthma education programs are improvement of asthma control and reduction of exacerbations, with the resulting decrease in physician visits, emergency department visits, hospitalization and death.15
Shared Medical Appointments: Facilitating Care for Children With Asthma and Their Caregivers
2012, Journal of Pediatric Health CareCitation Excerpt :Working with time and cost constraints of current treatment models, providers fall short of recommended treatment goals, including follow-up health care visits, lung function testing, written asthma action plans, and other treatment goals set by the National Heart, Lung and Blood Institutes (NHLBI) (NHLBI, 2007). Studies show that additional time and effort on the part of the clinician to diagnose and treat patients or to teach patients and their families about asthma in a group setting improves asthma outcomes (Coffman, Cabana, Halpin, & Yelin, 2008; Gebert et al., 1998; Lurie, Bauer, & Brady, 2001). However, no evidence-based practice model that struck a balance between treatment cost-effectiveness and effective asthma-management policies was found in the literature.
Therapeutic education in asthma management
2007, Anales de PediatriaIllness perception and therapeutic adherence among children suffering asthma
2006, Pratiques Psychologiques