This site is intended for health professionals only

Improving asthma control: self-management plans

Fiona Costello
RGN DipAsthmaCare NARTC
Asthma Services Manager
National Asthma Campaign
London
W:www.asthma.org.uk

Asthma morbidity in the UK is significant, with five million people currently receiving treatment.(2) In addition to the substantial impact on the individuals who live with this long-term condition, asthma also puts a considerable burden on the NHS and the economy of the UK as a whole. In 1995/96, the cost of primary care consultations for asthma was estimated to be almost £60m per year.(3,4)

Benefits of self-management
The need to improve the way people manage their own asthma is highlighted by the National Asthma Campaign's "Needs of People with Asthma" study, conducted in 2000, which revealed that many are living with poorly controlled symptoms that seriously disrupt their everyday lives. The impact of asthma extends beyond the individual, placing a considerable financial burden on the UK healthcare system and the economy, with an estimated annual cost of over £850m based on the number of people currently being treated and over 18m working days lost.(2)

Evidence shows that with good support from their doctor or practice nurse people can have improved health if they take the lead themselves in managing their long-term condition. Studies show that when people with asthma use written self-management plans, they have fewer asthma attacks and emergency hospital admissions. In the UK in 1999 there were 73,929 admissions to hospital due to asthma.(2)

The National Asthma Campaign's "Be in Control" initiative aims to have written self-management plans available to and used by more people with asthma. It is a call to action for healthcare professionals to ensure they offer written personal asthma plans as an integral part of routine asthma care. Asthma self-management programmes improve a range of health outcomes, including:

  • Reduction in asthma symptoms.
  • Improvement in lung function.
  • Reduction in attack frequency due to prompt response to deterioration in condition.
  • Reduction in requirement for reliever treatment.
  • Reduction in requirement for oral steroid tablets and less inappropriate use of antibiotics.
  • Improvements in compliance.
  • Improvements in quality of life.

Written self-management plans also result in cost benefits, saving up to £7 for every £1.60 spent on implementing a self-management programme.(5) They can reduce the use of healthcare resources, including accident and emergency visits, unscheduled physician visits, hospitalisations and readmissions to hospital, as well as reducing time off work or school.

Barriers to the use of written self-management plans
Research carried out by the National Asthma Campaign with over 600 healthcare professionals found that written advice on asthma self-management is not given. However, there was a common belief among those surveyed, which included practice nurses, GPs, hospital nurses and doctors, that written plans are more effective. This viewpoint is supported by the evidence for the benefits of self-management plans, but is not reflected in practice. In the great majority of cases, advice was only given verbally.
 
The health professionals surveyed identified three common reasons why they did not use asthma self-management plans:

  • Lack of time in patient consultations.
  • Plans not appropriate for all patients.
  • The complex formats of current self-management plans.

They stated that asthma self-management plans needed to be simple, easy to use and provided in a written format. In response to this, the National Asthma Campaign developed its "Be in Control" materials to help increase the use of self-management plans.

"Be in Control" initiative
The healthcare professionals surveyed were also consulted to identify the style and content of self-management materials, which will encourage patients and healthcare professionals alike to use self-management plans. The top three essential components of a written self-management plan were identified as:

  • What to do in an emergency.
  • What inhaler to use, when and how to use it, and at what dose.
  • How to recognise symptom deterioration.

These three elements form the basis of the "Be in Control" materials aimed to make self-management a priority for people with asthma and healthcare professionals. The materials include:

  • A personal asthma plan - for use by anyone who has asthma. It provides the basic and essential ­information that all people with asthma need to know in order to effectively manage their condition.
  • A personal asthma diary - more detailed ­information for people who have moderate to severe asthma or with a particular need to monitor their condition more closely.
  • Ask the right questions - a tear-off pad that provides guidance to people with asthma about the right questions to ask their healthcare professional during routine and follow-up consultations.

Taking on the self-management challenge
To reap the benefits of the "Be in Control" initiative, the National Asthma Campaign needs the support of healthcare professionals and Primary Care Trusts to promote the use of the materials across general practice. To improve the cost-effectiveness of asthma management, trusts need to select asthma as an area for health improvement, review the training of health professionals within the trust, and ensure that self-management is used, where appropriate, within asthma management. Delivery of asthma care by trained nurses is associated with improved asthma outcomes within primary care.(6) If health professionals are being asked to undertake asthma care without training, they should apply to their trust for support.

Greater provision of written self-management plans and a supply of simple, well-designed aids to management, such as the "Be in Control" materials, would help improve self-management for patients with asthma and improve asthma outcomes.

References

  1. Price D, Wolfe S. Delivery of asthma care: patients' use of and views on healthcare services, as determined from a nationwide interview survey. Asthma J 2000;5:141-4.
  2. National Asthma Campaign. Out in the open - true picture of asthma in the UK today. Asthma J 2001;6(3):5-11.
  3. Royal College of General Practitioners, Office of Population Censuses and Surveys and the Department of Health. Morbidity Statistics from General Practice. Fourth National Study 1991-1992. Series MB5 No. 3. London: HMSO; 1995.
  4. PSSRU. Unit costs of health and social care. Kent: PSSRU; 1997.
  5. Lahdensuo A. Guided self managed asthma. BMJ 1999;319:759-60.
  6. Neville R. Patient education and guided self management plans. Respir Med 1996;90:385-6.

Further reading
Asthma - Who's in Control? Review of evidence for the use of asthma self-management. For a free copy, contact the National Asthma Campaign
T:020 7704 5853
Gibson PG, et al. Self-management education and regular practitioner review for adults with asthma. In: Cochrane Collaboration Library, Issue 2.Oxford Update Software; 1999