Evaluation of self-care manual in bronchial asthma.

ABSTRACT

BACKGROUND: Asthma continues to be a substantial cause of morbidity. Various educational programmes have shown an increase in knowledge and self-management skills of asthmatic patients and also revealed a reduction of severe attacks, hospitalisations and days lost from work. METHODS: A self-care manual on bronchial asthma was prepared. A total of 523 bronchial asthma patients were enrolled in the study. Out of these, 260 patients were included in the study group to whom self-care manual was provided and 263 were included in the control group to whom no specific instructions were given. After the initial interview (0 week), follow up of all the patients was carried out at two weeks, six months and at one year. RESULTS: Out of the enrolled patients, 240 (92.31%) and 240 (91.25%), 212 (81.54%) and 210 (79.85%), and 204 (78.46%) and 194 (73.76%) patients completed the follow up at two weeks, six months and one year in the two groups, respectively. Various parameters analysed were knowledge of the patients, their symptomatology, various triggering factors which were inducing and/or precipitating symptoms, the self-care measures they adopted at the time of acute attacks and the indices of asthma morbidity during the last one year. The knowledge scores were significantly higher at all the three follow up visits (F = 633. 98, p < 0.001) as compared to the baseline in the study group patients. In both the groups, the symptom scores decreased at all the follow up visits (F = 71.78, p < 0.001 in the study group and F = 24.19, p < 0.001 in the control group). Multiple logistic regression analysis showed a significant improvement in knowledge and symptoms in the study group as compared to controls after adjusting for various confounding variables (p < 0.001). The number of patients whose symptoms were induced and/or precipitated by exposure to various triggering factors was significantly reduced in study group for all the triggers. There was a statistically significant decrease in the number of severe attacks, number of emergency visits and need of injections during last one year in both the groups, though the differences were more marked in the study group. However, there was a significant decrease in hospital admissions and absence from school/or job in the study group at one year as compared to the control group. CONCLUSION: The self-care manual was effective in self-management of bronchial asthma.