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Guided Self Management
Guided self management of asthma is a treatment strategy in which patients are taught to act appropriately when the first signs of asthma exacerbations appear.
Self management programmes containes a written action plan showing patients how to act in early exacerbations which will reduce the number of to hospital than programmes without a plan.
* About 75% of admissions for asthma are avoidable * Potentially preventable factors are common in deaths from asthma. * At least 40% of people with asthma do not react appropriately when their symptoms worsen * Over 50% of patients admitted with acute asthma have had alarming symptoms for at least a week before admission. * As many as 60% of asthmatic patients are poor at judging their dyspnoea.
Self management of asthma involves the patient making therapeutic, behavioural and environmental adjustments in accordance with advice from healthcare professionals.
Need for Self Management of Asthma * Insidious deterioration (common in asthma) * Three quarters of asthma exacerbations resulting in hospital care are preventable. * Nearly half of patients react inappropriately to asthma exacerbations * Poor perception of deteriorating dyspnoea * Proved value of patient education in the treatment of asthma * Poor compliance (30-40%) with asthma drugs
Practice Points * Self management of asthma prevents exacerbations, improves care and is a cost effective investment. * Patient education is crucial and should be given in a structured way * Patients should be taught to understand their symptoms and to monitor peak expiratory flow at home * Patients should know how to act when signs of asthma deterioration first appear * There should always be supervision of and continuity in asthma care A reasonable self management skill should be given to the asthma patients. The patient education for asthma can be conducted in many settings, like hospitals, emergency rooms, general practices, community organisations, hospital outpatient clinics etc. Group sessions plus councelling is the most effective method for educating asthmatic patients.
Although asthmatic patients have a strong desire to be informed about their illness, their individual backgrounds will influence the extent to which they utilise information. The patient's own responsibility for treatment is crucial, and building a firm partnership with the patient is the key to success. In asthma self management the patients should not be seen as objects for treatment but rather as active participants in a treatment team.
Self Management Skills
Patients should: * Accept that asthma is a long term and treatable disease * Be able to accurately describe asthma and its treatment * Actively participate in the control and management of their asthma * Identify factors that make their asthma worse * Be able to describe strategies for avoidance or reduction of exacerbating factors * Recognise the signs and symptoms of worsening asthma * Follow a prescribed written treatment plan * Use correct technique for taking drugs including inhalants by matered dose inhalers, dry powder inhalers, diskhalers, spacers or nebulisers. * Take appropriate action to prevent and treat symptoms in different situations * Use medical resources appropriately for routine and acute care * Monitor symptoms and objective measures of asthma control * Identify barriers to compliance (adherence) to the treatment plan * Address specific problems that have an impact on their individual condition.
Warning signs of asthma exacerbation * Increased dyspnoea * A combination of increased wheeze, cough or mucus secretion * Nocturnal asthma * Increased use of short acting sympathomimetics * Increased exercise induced asthma * Decreased morning peak expiratory flow values
The successful intervention combines the provision of information with individual self treatment plans. Such action plans may be based on symptoms, peak expiratory flow values or both. It is essential that patients notice exacerbations in their asthma early enough and start appropriate interventions by themselves. Self management programmes for asthma can use different action
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