Patient education programme in bronchial asthma in India: why, how, what and where to communicate?

Judicious and prolonged use of 'protector' metered dose inhalers of steroid aerosol, sodium cromoglycate, both orally and nasally, and 'reliever' drugs like beta 2-agonists etc can induce a state of controlled asthma in many cases. Continued patient education programme (PEP) in a well-staffed asthma clinic is needed to achieve this state. Various aspects of PEP programme should be discussed during each visit. Presence of superstition, misconceptions, ignorance and strong bias against the use of metered-dose inhalers should be removed during PEP. Poor level of literacy, language-barrier, poverty and inadequate contingency fund for prolonged treatment in most families, poor medical infrastructure, inadequate health care facilities, overcrowding in all hospitals, insufficient para-medical staff-pattern (even in private hospitals), high cost of inhalers, tendency for early discontinuation of protector drugs, dislike for prolonged supervision and follow-up investigations, distrust for doctors, fear of social stigma, lure for homeopathy and indigenous branch of medicine for children, etc., are some of the many problems, peculiar to our country, to be faced during PEP. Because of the presence of adequate medical and primary health care services, PEP in developed and affluent Western countries is liable to differ from what is advised here.