Asthma is a serious, chronic, and potentially life-threatening disease affecting 10-13 million persons in the United States. The disease has major societal impact, causing, restricted activity due to symptoms and millions of outpatient visits per year. Airway inflammation is thought to be a critical and central component of asthma pathogenesis. Current management approaches require that patients correctly carry out complex treatment regimens. However, these approaches depend heavily on the patient's understanding and skill in carrying out self-management to decrease asthma complications. Asthma education is mandated for all people with asthma (National Asthma Education Program, 1991) but must be accomplished efficiently as part of routine medical care. The overall objective of this project is to study the impact of an Asthma Education Intervention, designed to fit the context of the usual medical care appointment, on clinical markers of asthma control and biological markers of airway inflammation in samples of induced sputum. Clinical markers of asthma control include measures of symptom intensity, pulmonary function, and frequency of inhaled beta agonist use. These markers are affected by successful self-management through consistent and correct use of inhaled medication. The primary clinical outcome of this study is reduction of symptom intensity. Biological markers of airway inflammation include cell counts, differential eosinophilic cationic protein (ECP), and albumin in sputum of asthmatic subjects. The primary biological outcome of this study is reduction of the reduction of the concentration of ECP in sputum.
The specific aims are: (1) to test the impact of the Asthma Patient Education Intervention on the primary clinical outcome, symptom intensity, and the primary biological outcome, concentration of (ECP) in sputum samples; and, (2) to describe the effect of the Asthma Education Intervention on secondary clinical and biological markers of asthma control: peak flow, frequency of beta agonist use, pulmonary function, and quantity of eosinophils, neutrophils, and albumin in induced sputum samples of asthmatics. The findings of this study will lead to further refinement and selection of useful outcomes to monitor the effect of asthma educational interventions. A prospective, randomized control trial will be used with 54 adult subjects with asthma assigned to an Intervention or Control group. The Intervention group will receive a 30-minute Asthma Education Intervention, with Information and behavioral components, which is repeated three times at two week intervals. Symptoms, peak flow, and beta agonist frequency will be recorded daily, pulmonary function will be recorded at each of 5 visits over 9 weeks, and constituents of sputum will be analyzed pre- and post- intervention. The long term contribution of this project is to improve control of asthma by providing patients with essential information and skills needed to self-manage the illness, and to determine the usefulness of monitoring biological as well as clinical outcomes of nursing intervention.
| Janson, Susan L; McGrath, Kelly Wong; Covington, Jack K et al. (2009) Individualized asthma self-management improves medication adherence and markers of asthma control. J Allergy Clin Immunol 123:840-6 |
