Asthma is a chronic disease with considerable morbidity and mortality. Even those with mild asthma can experience a life-threatening event, and nearly 55% of adults with asthma have poor disease control. Asthma self-management (ASM) training provides instruction on desired medication, monitoring, and trigger avoidance behaviors. Together, these ASM “best practices” are strongly linked to enhanced asthma control and reduced attacks. Certification as an asthma educator (AE-Cs) indicates that the certificant possesses expert knowledge of these 3 critical elements of ASM training, as well as proficiency in the delivery of programs in diverse populations. Unfortunately, due to the limited number of AE-Cs in comparison to the number of individuals with asthma, the task of providing ASM training often falls on members of the health care team who do not have the same knowledge base as AE-Cs or other asthma specialists, such as experienced respiratory therapists or board-certified allergists. To meet the increasing demands for ASM training in the face of the limited number of AE-Cs, all providers must be engaged in the delivery of training. This article serves as a primer for those who deliver training but are uncertain as to what the National Asthma Education and Prevention Program’s Expert Panel Report-3 indicates are the essential components of an ASM curriculum.
National Institutes of Health; National Heart, Lung and Blood Institute. Expert Panel Report: Guidelines for the diagnosis and management of asthma (National Asthma Education and Prevention Program). http://www.nhlbi.nih.gov/guidelines/asthma/. PublishedJuly2007. Accessed October 20, 2011.
2.
AkinbamiLJMoormanJELiuX. Asthma Prevalence, Health Care Use, and Mortality: United States, 2005-2009 (National Health Statistics Reports; No. 32). Hyattsville, MD: National Center for Health Statistics; 2011.
3.
PetersSPJonesCAHaselkornTMinkDRValacerDJWeissST. Real-world Evaluation of Asthma Control and Treatment (REACT): findings from a national Web-based survey. J Allergy Clin Immunol. 2007;119:1454-1461.
4.
PowellHGibsonPG. Options for self-management education for adults with asthma. Cochrane Database Syst Rev. 2003;(1):CD004107.
ShahMRWhellanDJPetersonED. Delivering heart failure disease management in 3 tertiary care centers: key clinical components and venues of care. Am Heart J. 2008;155:764.e1-764.e5.
7.
BrachaYBrottmanGMCarlsonA. Physicians, guidelines, and cognitive tasks. Eval Health Prof. 2011;34:309-335.
8.
National Asthma Educator Certification Board. http://www.naecb.org/. Accessed October 20, 2011.
9.
Centers for Disease Control and Prevention. Asthma self-management education among youths and adults—United States, 2003. MMWR Morb Mortal Wkly Rep. 2007;56:912-915.
10.
US Department of Health and Human Services. Healthy People 2010. Conference Ed., 2 Vols. Washington, DC: US Department of Health and Human Services; 2000. http://www.health.gov/healthypeople. Accessed October 20, 2011.
11.
Center for the Advancement of Health & Center for Health Studies, Group Health Cooperative of Puget Sound. An Indexed Bibliography on Self-Management for People With Chronic DiseaseJ. (p. 1). Washington, DC: Center for the Advancement of Health; 1996.
12.
LorigKRHolman, HR Self management Education: History, Definition, Outcomes, and MechanismsAnn Behav Med 2003, 26(1):1–7.
13.
Center for the Advancement of Health & Center for Health Studies, Group Health Cooperative of Puget Sound. An Indexed Bibliography on Self-Management for People With Chronic Disease. Washington, DC: Center for the Advancement of Health; 1996.
14.
HowellG. Nonadherence to medical therapy in asthma: risk factors, barriers, and strategies for improving. J Asthma. 2008;45:723-729.
15.
IngersollKSCohenJ. The impact of medication regimen factors on adherence to chronic treatment: a review of literature. J Behav Med. 2008;31:213-224.
16.
HolgateSTPriceDValovirtaE. Asthma out of control? A structured review of recent patient surveys. BMC Pulm Med. 2006;6(suppl 1):S2.
17.
SennaGRidoloECalderonMLombardiCCanonicaGWPassalacquaG. Evidence of adherence to allergen-specific immunotherapy. Curr Opin Allergy Clin Immunol. 2009;9:544-548.
18.
HalmEAMoraPLeventhalH. No symptoms, no asthma: the acute episodic disease belief is associated with poor self-management among inner-city adults with persistent asthma. Chest. 2006;129:573-580.
19.
ReedCE. Inhaled corticosteroids: why do physicians and patients fail to comply with guidelines for managing asthma?Mayo Clin Proc. 2004;79:453-455.
20.
ApterAJBostonRCGeorgeM. The potentially modifiable barriers to adherence: it’s not just black and white. J Allergy Clin Immunol. 2003;111:1219-1226.
21.
PerrinKWilliamsMWijesingheMJamesKWeatherallMBeasleyR. Randomized controlled trial of adherence with single or combination inhaled corticosteroid/long-acting beta-agonist inhaler therapy in asthma. J Allergy Clin Immunol. 2010;126:505-510.
22.
GossecLTubachFDougadosMRavaudP. Reporting of adherence to medication in recent randomized controlled trials of 6 chronic diseases: a systematic literature review. Am J Med Sci. 2007;334:248-254.
23.
The Childhood Asthma Management Program Research Group. Long-term effects of budesonide or nedocromil in children with asthma. N Engl J Med. 2000;343:1054-1063.
24.
SuissaSErnstPBenayounSBaltzanMCaiB. Low-dose inhaled corticosteroids and the prevention of death from asthma. N Engl J Med. 2000;343:332-336.
25.
SinDDManSF. Low-dose inhaled corticosteroid therapy and risk of emergency department visits for asthma. Arch Intern Med. 2002;162:1591-1595.
26.
GeorgeMCampbellJRandC. Self-management of acute asthma among low-income urban adults. J Asthma. 2009;46:618-624.
27.
ChrystynHPriceD. Not all asthma inhalers are the same: factors to consider when prescribing an inhaler. Prim Care Respir J. 2009;18:243-249.
28.
BroedersMESanchisJLevyMLCromptonGKDekhuijzenPN; ADMIT Working Group. The ADMIT series—issues in inhalation therapy. 2. Improving technique and clinical effectiveness. Prim Care Respir J. 2009;18:76-82.
29.
HaughneyJPriceDKaplanA. Achieving asthma control in practice: understanding the reasons for poor control. Respir Med. 2008;102:1681-1693.
30.
YawnBP. Factors accounting for asthma variability: achieving optimal symptom control for individual patients. Prim Care Respir J. 2008;17:138-147.
31.
LavoriniFMagnanADubusJC. Effect of incorrect use of dry powder inhalers on management of patients with asthma and COPD. Respir Med. 2008;102:593-604.
32.
CromptonGKBarnesPJBroedersM; Aerosol Drug Management Improvement Team. The need to improve inhalation technique in Europe: a report from the Aerosol Drug Management Improvement Team. Respir Med. 2006;100:1479-1494.
33.
BeasleyRPearceNCraneJBurgessC. Beta-agonists: what is the evidence that their use increases the risk of asthma morbidity and mortality?J Allergy Clin Immunol. 1999;104(2, pt 2):S18-S30.
34.
CockcroftDW. As-needed inhaled beta2-adrenoceptor agonists in moderate-to-severe asthma: current recommendations. Treat Respir Med. 2005;4:169-174.
35.
JalbaMS. Three generations of ongoing controversies concerning the use of short acting beta-agonist therapy in asthma: a review. J Asthma. 2008;45:9-18.
36.
Asthma and Allergy Network, Mother of Asthmatics. (2010). South Dakota is 50th state to protect students’ rights to carry and self-administer asthma medication. http://www.aanma.org/advocacy/meds-at-school. Accessed October 20, 2011.
37.
National Institutes of Health; National Heart, Lung and Blood Institute, National Asthma Education and Prevention Program. When should students with asthma or allergies carry and self-administer emergency medications at school? Guidance for health care providers who prescribe emergency medications. http://www.nhlbi.nih.gov/health/prof/lung/asthma/emer_med.htm. PublishedMarch2005. Accessed October 20, 2011.
38.
CicuttoL. Supporting successful asthma management in schools: the role of asthma care providers. J Allergy Clin Immunol. 2009;124:390-393.
39.
PowellHGibsonPG. Options for self-management education for adults with asthma. Cochrane Database Syst Rev. 2003;(1):CD004107.
40.
BhogalSZemekRDucharmeFM. Written action plans for asthma in children. Cochrane Database Syst Rev. 2006;(3):CD005306.
41.
National Institutes of Health; National Heart, Lung and Blood Institute. Guidelines for the Diagnosis and Management of Asthma. Bethesda, MD: National Heart, Lung and Blood Institute; 1991.
42.
ReddelHToelleBGMarksGBWareSIJenkinsCRWoolcockAJ. Analysis of adherence to peak flow monitoring when recording of data is electronic. Thorax. 2007;62:741-742.
43.
NazirZRazaqSMirS. Revisiting the accuracy of peak flow meters: a double-blind study using formal methods of agreement. Respir Med. 2005;99:592-595.
44.
WallensteinGVCarranza-RosenzweigJKosinskiMBlaisdell-GrossBGajriaKJhingranP. A psychometric comparison of three patient-based measures of asthma control. Curr Med Res Opin. 2007;23:369-377.
45.
ConnollyCK. Falsely high peak expiratory flow readings due to acceleration in the mouth. BMJ. 1987;294:285.
