Education

Asthma There is content specific to the teaching of asthma management and symptoms for children and adults in Guidelines for the Diagnosis and Management of Asthma.122 Optimal self-management components in an asthma education program include: information and facts about asthma including correct inhaler use; self-monitoring of peak flow and/or symptoms; written action plan allowing self-adjustment of medications (individual); and regular clinician review of asthma control and medications. Education about symptoms in asthma is typically integrated into a self-management program. A meta-analysis of 12 studies of asthma self-management programs found that those that included 'education only' significantly improved knowledge of facts and improved perceived symptoms.123 However, these 'education only' programs had no effect on hospitalizations, ER visits, unscheduled MD visits, lung function, medication use or days lost from work. In contrast, a more recent meta-analysis found that self-management programs that included not just education, but also medical review, self-monitoring of PEFR and symptoms, and a written action plan allowing self-management of medications resulted in decreased resource utilization,124 nocturnal asthma,125 symptoms,126 and improved quality of life124 when compared to usual controls.

COPD There has been much less study of educational or self-management programs for COPD patients. At present most of the education for COPD patients occurs as one component in structured pulmonary rehabilitation programs. Therefore, the effect of that education component alone has not been sufficiently studied. The individual programs for COPD that included only education and limited skills training have not significantly improved

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dyspnea. ' ' - With programs that have included education about dyspnea self-management strategies coupled with some type of exercise and reinforcing phone calls, a decrease was found in dyspnea with laboratory exercise sessions, a decrease in dyspnea with ADL was found after additional supervised exercise, and a decrease in dyspnea with ADL was found with with a home walking prescription.113 Recent programs for patients with COPD that have provided self-management education, action plans, and prescriptions for antibiotics and steroids coupled with home visits, a limited exercise program, and regularly scheduled follow-up phone calls120'131-133 reported significant reductions in healthcare utilization compared to usual care groups. This decrease in healthcare utilization could be presumed to mirror a reduction in symptoms, however, which component of these multi-treatment programs had the primary effect on the outcomes is unknown.

Lung cancer One group of investigators has reported a successful nurse clinic for lung cancer patients who completed the 'first line of treatment'.134,135 A nursing clinic intervention for breathlessness patients was compared to a supportive group that received standard treatment for breathlessness during a weekly clinic visit. The nursing clinic consisted of assessment of breathlessness, teaching effective ways of coping with dyspnea, exploration of the meaning of dyspnea, breathing control, activity pacing, relaxation techniques, and psychosocial support. The intervention group improved their dyspnea at rest, performance status, and physical and emotional status significantly more than the control group at eight weeks. It is noteworthy that this nursing intervention improved dyspnea without an exercise prescription which has not been true of several other education only programs as discussed above.

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