Clinical effectiveness of self management of asthma in general practice: a randomised controlled trial

AIM: To assess the effects of a guided self management program for steroid dependent asthmatics in general practice on asthma control and quality of life. METHODS: Nineteen General Practices were randomly allocated to usual care (UC) or a self management program (GSM). Follow up was two years. Patients kept diary cards and visited the lung function laboratory every six months. Outcomes were the number of successfully treated weeks, asthma specific quality of life, FEV1, FEV1 -reversibility, PC20 -histamine and the amount of inhaled steroids. RESULTS: 214 patients were included (104 UC / 110 GSM) and 171 completed the 2-year follow up (86 UC / 85 GSM). Selected patients were predominantly female (62%). The mean number of STWs in two years time was 81 (95% CI 78; 84) for GSM and 75 (95% CI 72; 78) for UC, corresponding with a statistically significant gain of 6 STWs in two years in favour of self-management. Based on repeated measurements analysis the estimated increase in the overall asthma quality of life score was 0.10 points per visit in the UC group versus 0.21 points per visit in the GSM group(P=0.055). There were no statistically significant changes in FEV1, reversibility of FEV1 and PC20-histamine. After two years mean budesonide usage was 1680 puffs (95% CI 1538; 1822) for self-management and 1897 puffs (95% CI 1679; 2115) for usual care, indicating a statistically significant saving of 217 puffs. CONCLUSION: Self management resulted in a higher number of successfully treated weeks and improvements in quality of life without compromising asthma control and with savings in the amount of inhaled steroids used.