Asthma education, monitoring and environmental control

Asthma treatment in the last 10 years has benefited greatly from the first and second reports of the National Asthma Education and Prevention Program expert panel. Newer approaches to medical therapy have been accompanied by more aggressive attempts to involve patients in the management of their disease. In fact, it is widely recognized that the patient has a very important role in asthma management. As indicated by the section title, symptom and peak flow monitoring, along with environmental control, are essential topics for patient education. This review covers the three related areas of education, monitoring and environmental control, as well as the associated salient issues addressed in recent asthma prevention and control literature. The first section covers essential elements of asthma education. A review of current research and recommendations includes a brief synopsis of the expert panel recommendations for patient and family education and summarizes recent controlled trials of asthma self management interventions for both children and adults. The results of these trials raise the question of incremental gains in patient outcomes seen with increasing intensity of asthma self management interventions. Suggestions for future directions for self management research are included in this and the following two sections. The second section focuses primarily on research related to the role of self monitoring in asthma care and the relative advantages of using a peak flow meter and/or symptoms to assess the need for a step up in treatment. The final section addresses environmental control as it relates to self management and looks at the burgeoning literature on the role of household environmental monitoring and control for the prevention of sensitization and subsequent morbidity from exposure to allergens and irritants. The importance of the patient and family in environmental control is emphasized.