ABSTRACT
Therapeutic patient education (TPE) has been standard practice in France for roughly 20 years. However, TPE has only recently been officially recognized and has rarely been assessed. The objective of this study was to assess the impact of TPE on passive smoking exposure and asthma outcomes in young patients referred to a hospital school for children with asthma. A prospective cohort study was conducted to determine the socio-economic status, environmental exposure (including parental tobacco consumption) and medical history of children starting out on a TPE course. The study measured quality of life and urinary cotinine. Asthma control was also assessed. Out of a total of 54 children (median age 8.6 years), 35 and 26 children attended three or at least four TPE sessions, respectively. Uncontrolled asthma and a history of hospitalization for exacerbation of asthma were frequent (43% and 61%, respectively). In utero passive smoke exposure was more frequent in the hospitalization group (p = 0.07). Urinary cotinine levels were similar in children exposed and not exposed to tobacco smoke (259 vs 141 nMol.L-1, p = 0.15), but only decreased in the group of exposed children. In 34 children, quality of life improved significantly between the first and the third or fourth sessions (n = 23, median increase 1.06, p = 0.1), while asthma control improved in 64% of the patients (n = 33, p = 0.01) and emergency attendances decreased (n = 34, p = 0.001). The positive effects of TPE on asthma control and quality of life were quickly visible but did not prevent children from withdrawing from the program. Urinary cotinine was not useful for detecting exposure to tobacco smoke, but may be useful as an indicator of exposure to tobacco smoke. The results indicate an improvement in quality of life and asthma control as TPE proceeded.
