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International guidelines and educational experiences in an out-patient clinic for asthma
S Aiolfi1, M Confalonieri, A Scartabellati
1Dept of Pneumology, Crema Hospital, Italy.
Insights
An asthma clinic improved patient management, but a structured asthma school did not significantly reduce urgent visits or hospital admissions compared to standard care. Further research is needed for effective asthma education strategies.
Area of Science:
- Pulmonology
- Clinical Medicine
- Public Health
Background:
- An outpatient asthma clinic was established at Crema Hospital, Italy, in June 1989.
- 430 adult asthmatics were managed according to international guidelines between 1989 and 1994.
- Initial assessment revealed varying asthma severity, with 170 patients having forced expiratory volume in one second (FEV1) < 80% and 27 patients having arterial oxygen tension (Pa,O2) < 8.0 kPa.
Purpose of the Study:
- To evaluate if the asthma clinic could effectively control asthma and reduce hospital admissions.
- To assess if a structured educational approach, the 'school of asthma,' could improve asthma symptom control and reduce admissions.
Main Methods:
- Retrospective analysis of data from the first 360 adult asthmatics managed at the clinic.
- A randomized controlled trial involving 44 patients to evaluate the 'school of asthma' intervention.
- Patients were stratified by asthma severity (mild, moderate, severe) and randomized into intervention (attended school) and control groups.
Main Results:
- The asthma clinic managed patients classified as mild (53%), moderate (27%), and severe (20%).
- After one year, the 'school of asthma' group showed no significant difference in urgent care visits, scheduled visits, or hospital admissions compared to the control group.
- Both groups had identical numbers of urgent care visits (9) and hospital admissions (2), with similar scheduled visits (22 vs. 21).
Conclusions:
- The established asthma clinic organization was effective in managing adult asthmatics.
- The implemented 'school of asthma' educational program did not demonstrate a significant benefit in reducing urgent care visits or hospital admissions.
- Further investigation into optimized asthma educational strategies is warranted.
Abstract:
In June 1989, an out-patient clinic for asthma was instituted at Crema Hospital, Italy. Up to November 1994, 430 adult asthmatics were recruited, classified and managed according to the recommendations of the international guidelines. The aims of this study are to verify: 1) whether the organization of the clinic could maintain asthma under control and reduce hospital admissions; and 2) whether the traditional educational approach could be implemented by lessons in the school of asthma to improve the control of asthma symptoms and/or admissions. The data reported refer to the first 360 asthmatics attending the clinic between 1989 and 1994: 53, 45 and 2% of them were suffering from extrinsic, intrinsic and occupational asthma, respectively. On recruitment, forced expiratory volume in one second (FEV1) was < 80% of predicted in 170 patients, and arterial oxygen tension (Pa,O2) 8.0 kPa (< 60 mmHg) in 27 patients. After the admission visit, 190 patients (53%) were classified as mild, 97 (27%) as moderate, and 73 (20%) as severe asthmatics. In May 1993, a school of asthma was organized. Forty four patients were recruited, stratified according to the severity of their asthma and randomized into two groups: 22 patients attended the school, and 22 patients did not. Each group consisted of 5, 10 and 7 patients with mild, moderate and severe asthma, respectively. The school comprised four lessons twice a week. One year after the end of the school, we could find no differences between the two groups (school versus controls) with regard to the number of urgent care visits (9 vs 9), scheduled visits (22 vs 21) and hospital admissions (2 vs 2).