Delivering asthma education to special high risk groups
Introduction
In recent years there has been concern regarding rising rates of asthma [1]and in addition asthma mortality [2]and near fatal asthma(NFA) [3]. Although rates of asthma mortality are declining in many Western countries 4, 5much still needs to be done. Along with the changing epidemiology of asthma the role of inflammation in the pathogenesis of asthma has been recognized and has focused our attention on the therapeutic importance of anti-inflammatory therapy [6]. Recent evidence based asthma guidelines have highlighted the importance of such therapy [7].
A better awareness of the chronic nature of asthma has also led to greater emphasis on the role of asthma education in its management [8]. In this article we will outline the characteristics of those at increased risk from their asthma i.e. those who have risk factors for NFA and fatal asthma; outline the barriers to the delivery of asthma education to such groups and finally review studies that have targeted these groups. We outlined future research needs in this area.
Section snippets
High risk groups
Characteristics of patients at high risk of asthma morbidity and mortality are outlined in Table 1. The single greatest risk factor for NFA is a prior history of intubation [9]. In a prospective study we have shown that patients with such a history have a twenty seven times higher risk of NFA than hospitalized controls [9]. Similarly a prior history of hospitalization or visit to the emergency room in the prior twelve months has been associated with an increased risk of fatal asthma [10]. In a
Delivering asthma education
Intuitively the delivery of an effective educational and therapeutic intervention to a high risk group should be more cost-effective than offering similar programs to less severe asthmatics. The objective is to reduce severe attacks that may be fatal or require hospitalization, subsequently improving quality of life and decreasing the utilization of the more expensive hospital based asthma resources. A 1992 study estimated that direct and indirect health care costs for asthma in the United
Future directions
In this brief review we have identified patients at increased risk from their asthma and by definition patients who should be candidates for focused asthma education. There is a need for further research into improving the delivery of asthma education to these high risk patients (Table 5). In addition, their management will only become optimal if the physicians and allied health care workers caring for them provide an integrated approach based on evidenced based principles [52]. Although
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