A self-management program for adult asthma. Part I: Development and evaluation.

BACKGROUND: We developed and evaluated a self-management program for adult asthma. In developing the program, we considered questions of format and behavior control. The format we selected included components known to be effective in educational settings. We regulated asthma management behavior through the introduction of environmental cues. METHODS: Seventy-six subjects, whose asthma was generally under medical control, were assigned randomly to either a treatment group or a waiting-list control group. Those in the treatment group were exposed to a 7-week program that incorporated proven features of providing effective training and establishing behavioral control. Subsequently, subjects in the control group received the treatment. Short-term evaluation of the treatment was made after the subjects in the experimental group were trained but before the control subjects were trained. Long-term evaluation was conducted after both groups of subjects were trained. RESULTS: Over the short term, self-management training led to fewer asthma symptoms and physician visits and improvement in asthma management skills and cognitive abilities. Over the long term, self-management training was related to lower asthma attack frequency, reduced medication use, improvement in cognitive measures, and increased use of self-management skills. CONCLUSIONS: The program improved asthma management in patients whose conditions were already under good medical control. The effects of the program were apparent a year after the conclusion of self-management training.

Living with asthma: Part II. Beyond CARIH.

This article focuses on the evolution and assessment of additional self-management programs and strategies following the original development and evaluation of Living with Asthma. In particular, it describes the basis and philosophy underlying a self-management program for adults with asthma. In doing so, it introduces strategies that can be used by adults to process and evaluate the information they gather, and to make decisions as to what steps to take to predict and prevent asthma attacks. These strategies rely upon techniques ranging from the use of decision-making trees to the calculation of conditional probabilities to enhance the patients' knowledge that an attack is apt to occur within a prescribed period. It is hoped that further refinement of these procedures will not only provide greater control over asthma, but may help reverse the recent trend of increased mortality due to the disorder.

A method for studying controlled substance use: a preliminary investigation.

This study examined relapse following treatment in a smoking reduction program. Twenty-two smokers with an average daily smoking rate of 25.7 cigarettes were provided a reduction-oriented smoking self-management program. Subjects were then classified on the basis of their reduction at posttreatment. A 50% or greater reduction from pretreatment qualified subjects as successful reducers. To provide further understanding of controlled smoking, subjects who successfully maintained at least a 50% reduction (at three month follow-up) were compared to those subjects who were unable to maintain that level of reduced smoking. A set of cognitive, smoking history, and reduction motivation variables were used to compare the two groups in a stepwise discriminant function analysis. Two variables, internal locus of control and self-label as a nonsmoker, produced an overall correct classification rate of 88.9%. Multiple regression analyses further demonstrated the importance of these two cognitive variables; self-label and internal locus of control accounted for 50.4% of the variance in smoking at three months follow-up. The implications of these findings for future study of controlled smoking are discussed.

Direct and indirect costs associated with the management of childhood asthma.

The financial impact of childhood asthma has not been assessed since Vance and Taylor reported their data in Annals of Allergy 13 years ago. The present study updates the financial impact the direct costs (e.g., physician fees) have on families and assesses the indirect expenditures (e.g., income loss) associated with managing a child's asthma.