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Supported self-management for asthma

Hilary Pinnock
Breathe 2015 11: 98-109; DOI: 10.1183/20734735.015614
Hilary Pinnock
Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
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  • For correspondence: hilary.pinnock@ed.ac.uk
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Abstract

Key points

  • Self-management education in asthma is not an optional extra. Healthcare professionals have a responsibility to ensure that everyone with asthma has personalised advice to enable them to optimise how they self-manage their condition.

  • Overviews of the extensive evidence-base conclude that asthma self-management supported by regular professional review, improves asthma control, reduces exacerbations and admissions, and improves quality of life.

  • Self-management education should be reinforced by a written personalised asthma action plan which provides a summary of the regular management strategy, how to recognise deterioration and the action to take.

  • Successful implementation combines education for patients, skills training for professionals in the context of an organisation committed to both the concept and the practice of supported self-management.

Educational aims

  • To summarise the evidence base underpinning supported self-management for asthma

  • To provide clinicians with a practical approach to providing supported self-management for asthma

  • To suggest an appropriate strategy for implementing supported self-management

Summary The evidence in favour of supported self-management for asthma is overwhelming. Self-management including provision of a written asthma action plan and supported by regular medical review, almost halves the risk of hospitalisation, significantly reduces emergency department attendances and unscheduled consultations, and improves markers of asthma control and quality of life. Demographic and cultural tailoring enables effective programmes to be implemented in deprived and/or ethnic communities or within schools.

A crucial component of effective asthma self-management interventions is the provision of an agreed, written personalised action plan which advises on using regular medication, recognising deterioration and appropriate action to take. Monitoring can be based on symptoms or on peak flows and should specify thresholds for action including increasing inhaled steroids, commencing oral steroids, and when (and how) to seek professional help. Plans should be personalised to reflect asthma severity and treatment regimes, avoidance of triggers, co-morbid rhinitis and the individual’s preferences.

Implementation is a challenge. Systematic review evidence suggests that it is possible to implement asthma self-management in routine care, but that to be effective this requires a whole systems approach which considers implementation from the perspective of patient education and resources, professional skills and motivation and organisation priorities and routines.

Footnotes

  • The ERS designates this educational activity for a maximum of 1 CME credit. For information on how to earn CME credits, please visit www.ers-education.org/e-learning/cme-tests

  • Conflict of interest H. Pinnock has received a grant from the National Institute for Health Research, Health Services and Delivery Research Programme and chairs the self-management Evidence Review Group for the British Thoracic Society/Scottish Intercollegiate Guideline Network British Asthma Guideline.

  • ©ERS 2015

Breathe articles are open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.

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Supported self-management for asthma
Hilary Pinnock
Breathe Jun 2015, 11 (2) 98-109; DOI: 10.1183/20734735.015614

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Supported self-management for asthma
Hilary Pinnock
Breathe Jun 2015, 11 (2) 98-109; DOI: 10.1183/20734735.015614
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  • Article
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