Effect of educational programs on asthma control and qualitiy of life in adult asthma patients

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Abstract

This study investigated the effectiveness of different educational programs in obtaining better asthma control and asthma-related quality of life (QoL). In 60 adult patients with moderate persistent asthma we tested the benefit of individual verbal instructions (IVI), written information (“asthma booklet”, B), and integrated asthma classes (“asthma school”, AS). At the enrollment and at the end of the study, all participants completed the questionnaires regarding their asthma-related knowledge (ArK) and QoL. During the 12-week period all patients recorded their asthma symptoms, morning and evening peek expiratory flow rates (PEFR), and the use of rescue medication. AS and IVI groups showed a significantly greater improvement in QoL than the B group. AS group obtained the highest ArK but no difference in the level of improvement among the groups has been documented. The improved average asthma symptom score and decreased utilization of the rescue medication were documented in all groups without significant differences among them. We also found significant improvements in both morning and evening PEFR in IVI group as well as in the morning PEFR in AS group. We conclude that among tested educational interventions the AS caused the best improvement in QoL while IVI produced the best overall response in both parameters of the asthma control and QoL.

Introduction

Continuous education of patients with asthma enhances the probability of long-term asthma control and often has essential importance for successful management of all types of asthma [1]. Different educational programs for patients with asthma have been widely used for a long time [2], [3], [4], [5]. However, they largely differ in respect of content, design, intensity, and duration, depending largely on the quality of the educator. This variability resulted in lack of consensus in the respective field [6].

In spite of recommendations for teamwork and multidisciplinary approach in education of asthma patients, medical doctors and nurses still carry out the greatest part of patients’ education [7]. However, the combined form of individual and group education recently gained in its importance [5]. There is increasing evidence that permanent education of patients helped in better control and more successful treatment of asthma mostly due to encouragement of efficient self-care in accomplishing the set management targets [8], [9], [10]. In addition, there is a potential of educational assistance of pharmacists who could particularly help in adequate selection and proper usage of asthma medications [1], [11], [12].

According to published studies, educational programs for asthma patients resulted in improved control of asthma regarding the number and severity of asthma exacerbations, school and work absenteeism, medical resources utilization, asthma morbidity and mortality, and the rate of complications [13], [14].

The aim of the present study was to investigate the effectiveness of different forms of medical education in improving the control of asthma and quality of life (QoL) in patients with moderate persistent asthma. Different modalities of the patients’ education included integrated asthma classes (“asthma school”, AS), individual verbal instructions (IVI), and the education based on the usage of the written information—“asthma booklets” (B). The decision for recruitment of patients with moderate persistent asthma was based on their significant necessity for permanent medical care and regular controls. The possible effectiveness of a particular educational program in obtaining better asthma control in these patients could have a significant impact on overall healthcare expenses for asthma because of their significant proportion, high rate of exacerbations and hospital admittances [15].

Section snippets

Methods

The study was designed as randomized, parallel groups, prospective, intervention study in adult patients with moderate persistent asthma. The institutional Ethics Committee has approved the plan of the study and all participating patients signed written consents before the recruitment. Sixty consecutive patients with moderate persistent asthma were recruited into the study in the inpatient and outpatient wards of the Department for Clinical Immunology and Pulmology, General Hospital “Sveti

Results

Baseline subject characteristics are shown in Table 1. No significant differences between groups with exemption of gender distribution (P = 0.023, Chi-square test) were found. The groups were well balanced for baseline lung function parameters as well as for QoL and ArK (analysis of variance).

Discussion and conclusions

It is widely accepted that patients’ education is an essential part of the overall management of asthma. Therefore, the present study was aimed to investigate the effectiveness of different educational programs in obtaining better asthma control and asthma-related QoL.

Correspondingly to other reports [18], [19], [20], we found that the completion of programs of medical education in AS and IVI significantly increased the general asthma-related knowledge and awareness. In contrast, in group of

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