Asthma disease management: a critical analysis.

OBJECTIVE: To examine how effective a number of asthma disease management (DM) programs have been and whether they have been shown to improve patient outcomes cost-effectively. DATA SOURCES: Articles and meta-analyses from peer-reviewed journals or conference abstracts from 1991 to November 2003 were reviewed by searching MEDLINE and the external World Wide Web to provide examples of data. Terms used for searches included outcomes, intervention, specialist, self-management, asthma, pediatric, and cost-effectiveness. STUDY SELECTION: Observational studies that reported data on DM programs, comparisons of general and specialty care, or asthma self-management outcomes were selected for review. RESULTS: Recently, several studies have demonstrated the short-term benefit of asthma DM programs. These studies found that educational intervention programs produce measurable clinical and economic benefits in the intervention group; however, only a small percentage of patients remain compliant. In addition, the benefit of specialty care in asthma has been shown in other studies. CONCLUSIONS: Although long-term studies are needed to evaluate DM-mediated clinical and cost benefits compared with specialty care, any program that helps improve patient compliance will result in clinical and economic benefits.