How is asthma managed?
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Asthma Management: Strategies and Effectiveness
Self-Management Education and Regular Practitioner Review
Importance of Self-Management Education
Self-management education is a cornerstone of asthma management, significantly improving patient outcomes. Studies have shown that self-management education, when combined with regular medical reviews, reduces hospitalizations, emergency room visits, unscheduled doctor visits, and days off work or school1 6. These programs typically involve self-monitoring of symptoms or peak expiratory flow, and the use of individualized written action plans, which have been found to be particularly effective1 6.
Effectiveness in Adults
In adults, self-management education has been shown to improve health outcomes by reducing nocturnal asthma symptoms and enhancing the quality of life1 6. However, measures of lung function showed little change, indicating that while self-management improves symptom control and reduces healthcare utilization, it may not significantly alter lung function metrics1 6.
School-Based Interventions for Children
For children and adolescents, school-based self-management interventions have proven effective. These programs reduce hospital admissions, emergency department visits, and unplanned healthcare visits, while also decreasing the number of days with restricted activity due to asthma symptoms2. The success of these interventions is often linked to their theoretical framework, parental involvement, and the timing of the intervention outside of children's free time2.
Individualized Asthma Self-Management
Personalized Approaches
Individualized self-management education, which includes personalized action plans and environmental control strategies, has been shown to improve medication adherence and clinical markers of asthma control3. Patients receiving individualized education maintained higher adherence to inhaled corticosteroid therapy and experienced fewer nighttime awakenings and reduced use of inhaled beta-agonists3.
Long-Term Benefits
Long-term benefits of individualized self-management include sustained medication adherence and improved perceived control of asthma, which are crucial for preventing exacerbations and maintaining overall asthma control3.
General Practice and Asthma Control
Randomized Controlled Trials in General Practice
Randomized controlled trials in general practice settings have demonstrated that self-management is at least as effective as usual care. Patients in self-management programs reported fewer limited activity days and required fewer puffs of inhaled steroids, indicating a lower burden of illness5. These findings support the integration of self-management education into routine asthma care in primary care settings5.
Management of Asthma-COPD Overlap (ACO)
Treatment Recommendations
Patients with asthma-COPD overlap (ACO) often experience greater morbidity, and their management requires a tailored approach. Current recommendations suggest the use of long-acting bronchodilators in conjunction with inhaled corticosteroids, and the consideration of long-acting muscarinic antagonists as add-on treatments4. Advanced therapies based on phenotyping and identification of treatable traits may be necessary for patients who do not respond adequately to inhaler therapy4.
Conclusion
Asthma management strategies that incorporate self-management education, regular practitioner reviews, and individualized action plans are highly effective in improving patient outcomes. These approaches reduce healthcare utilization, improve medication adherence, and enhance the quality of life for both adults and children with asthma. For patients with asthma-COPD overlap, a combination of long-acting bronchodilators and inhaled corticosteroids is recommended, with advanced therapies considered for non-responders. Integrating these strategies into routine care can significantly reduce the burden of asthma and improve overall disease control.
Sources and full results
Most relevant research papers on this topic
Self-management education and regular practitioner review for adults with asthma.
Asthma self-management education, coupled with regular medical review and a written action plan, improves health outcomes and quality of life for adults with asthma.
Systematic Review
Highly CitedSchool-based self-management interventions for asthma in children and adolescents: a mixed methods systematic review.
School-based asthma self-management interventions in children can improve their condition by increasing knowledge, enhancing skills, and changing behavior, but require effective implementation and monitoring.
Systematic Review
Very Rigorous JournalHighly CitedIndividualized asthma self-management improves medication adherence and markers of asthma control.
Individualized asthma self-management education improves medication adherence and clinical markers of asthma control in adults with moderate-to-severe asthma.
RCT
Rigorous JournalHighly CitedManagement of Asthma COPD Overlap.
Patients with asthma COPD overlap should start with long-acting bronchodilator and inhaled corticosteroids, consider long-acting muscarinic antagonists, and consider advanced therapies based on phenotyping and treatable traits.
Systematic ReviewSelf-management of asthma in general practice, asthma control and quality of life: a randomised controlled trial
Self-management of asthma in general practice is as effective as usual care and safe for intermittent treatment with inhaled corticosteroids.
RCTHighly CitedSelf-management education and regular practitioner review for adults with asthma.
Asthma self-management education, coupled with regular medical review and a written action plan, improves health outcomes for adults with asthma, with self-adjustment of medications using a written plan being more effective.
Systematic ReviewHighly CitedGuided self management of asthma—how to do it
Guided self management of asthma reduces hospital admissions, emergency room visits, unscheduled doctor visits, and days off work or school, with a written action plan showing greater reduction in hospital admissions.
Systematic ReviewInternational consensus report on diagnosis and management of asthma
Effective asthma management involves patient education, avoidance of triggers, and pharmacologic treatment, with a focus on preventing exacerbations and maintaining normal lung function.
Highly CitedSelf-management improves asthma
Individualized self-management education improves asthma symptoms in adults, reducing emergency department visits and hospitalizations.
RCT2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group
The 2020 Focused Updates to Asthma Management Guidelines focus on six priority topic areas, incorporating new evidence-based recommendations and practical implementation guidance for asthma care.
Rigorous JournalHighly Cited