How could we support asthma patients to perform effective self-management
Published: October 18, 2021
Asthma is a common chronic respiratory disease worldwide and continues to contribute to the global economic burden. Poor asthma control affects not only quality of life of the patients, but also is associated with the need for emergency care and sometimes hospitalizations. Asthma self-management (i.e. self-monitoring together with a written asthma action plan and regular review by a healthcare provider) has been shown to be effective in improving asthma control. Findings from previous research suggested that regularly supported self-management can reduce healthcare use in patients with asthma. However, considering the variety of supportive interventions used and the complexity in delivery of such approaches, which strategy provides superior outcomes remains unclear.
A study by Dhippayom et al, which was recently published in The Journal of Allergy and Clinical Immunology: In Practice, has tried to identify the most effective approach that supports patients with asthma to perform self-management. The authors have comprehensively gathered information from previous clinical trials that explored the effect of an intervention aiming to support asthma self-management on asthma control, exacerbation, and lung function. They used a statistical method called network meta-analysis to compare findings from trials of different support strategies for asthma self-management. To classify various support strategies, they employed their newly developed TIP (Theme, Intensity, and Provider/Platform) framework that characterizes the type of intervention and how support strategies are delivered, i.e., how often and by whom or which platform. The theme of each intervention was classified into one of three groups: education, behavior, and psychosocial. The intensity of each intervention was classified into two groups, i.e. high intensity (more often than once a month throughout the study period), and low intensity (less often than or equal to once a month throughout the study period). The provider was grouped into 1) e-Health such as interactive computer software or mobile phone application, or 2) healthcare personnel.
The current evidence from 35 trials in 5,195 patients suggests that behavioral support on asthma self-management more often than once a month with the aid of e-Health may be better than other self-management strategies in optimizing asthma control. However, other elements, specifically the interaction with healthcare personnel, may play an important role in preventing the risk of asthma exacerbation. They also noted that patients with very good baseline lung function would be less likely to gain benefit in enhancing their lung function from a self-management support strategy. It appears that different features of asthma self-management support strategies work best on unique outcomes and depend on patients’ asthma baseline characteristics.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.