Asthma self-management programs can reduce the need for hospital-based asthma care

Mortality from asthma and its complications is increasing as is the expense associated with treating this disease. We hypothesized that an asthma-education program, already in place, had reduced hospitalizations (HOS) and emergency-department (ED) visits for asthmatic patients who participated.

We compared asthmatic patients' ED visits and HOS for the 12-month periods immediately before and after treatment in our center.

All patients received physician-directed medical management based upon the National Asthma Education Panel recommendations. One group (PART, n = 13) received instruction in self-management using the peak-flow meter (PFM) and an action plan (AP) to adjust medication dosages in response to changing post-bronchodilator peak-flow meter readings. Average cost for this intervention was $820 (2 visits, each with 60-90 minutes of instruction). The other group (FULL, n = 13), in addition to receiving a PFM and AP, completed a multidisciplinary education program stressing trigger identification and avoidance, environmental control, proactive adjustment of anti-inflammatory agents, and stress management. Average cost for this intervention was $1,700 (multidisciplinary evaluations and 12 hours of instruction). Those who did not enter the education program did so by choice or circumstance (ie, transportation problems, inability to commit the required time for the program, insurance denial).

Of the 13 PART-group subjects, 8 experienced all 31 ED and/or HOS in the year prior to our program. Four of 13 accounted for the 15 ED and/or HOS after discharge from the program (50% improvement, p < 0.05). Of the 14 patients in the FULL group, 7 accounted for 25 ED and/or HOS prior to the program. There were no ED and/or HOS after the program (100% improvement, p < 0.05).

Based on this sample, it is evident that both PART and FULL programs can significantly impact the frequency with which hospital-based asthma care is required and thus reduce the overall cost of caring for patients with asthma.