[Evaluation of a structured outpatient education program for adult asthmatics]. / Evaluation eines strukturierten ambulanten Schulungsprogramms für erwachsene Asthmatiker.

BACKGROUND AND OBJECTIVE: In this study the effectiveness of an outpatient education program for adult asthmatics (AFAS) was evaluated in a controlled and randomized trial over a period of 6 months. PATIENTS AND METHODS: In a randomized controlled study 78 educated patients with mild to moderate asthma (mean age 48.6 years) and 42 equally treated but "sham-trained" patients (control group; mean age 48.3 years) were compared after 6 months. The average duration of the disease was 16.7 years. Main items of the eight-hour outpatient education program were the peak-flow-controlled self-medication of the patients, the correct use of the medication, as well as information about the disease and its treatment. The patients of the control group underwent a "sham-training" (short education about inhalation technique and use of peak-flow meter). RESULTS: The knowledge about the disease, measured by a multiple-choice-test including 27 items, increased in the intervention group from initially 28.9+/-2 % to 90.0+/-3.6 % (p < 0.001). After AFAS 87.5 % of patients were able to manage their asthma attacks by themselves (initially 26.2 %; p = 0.009). Inhaled glucocorticoids were used more regularly (p = 0.037), the percentage of patients with mild and severe asthma attacks during the last weak decreased significantly (p < 0.001). The SF-12 life quality score increased significantly (p < 0.001). The control group revealed no significant differences in all these parameters. CONCLUSION: Judged by the reduction of morbidity and an optimization of the medication as well as a higher quality of life, AFAS under outpatient conditions appears to be an efficient and cost-effective method of modern asthma management.

Does patient education modify behaviour in the management of COPD?

With respect to the beneficial health effects of patient education in the treatment of asthma it might be expected that the active participation of COPD-patients in the management of their disease may reduce the burden of the disease. Self-management of chronic obstructive pulmonary disease (COPD) includes sufficient coping behaviour, compliance with inhaled medication, attention to changes in the severity of the disease, adequate inhalation technique, and self-adjustment of the medication in case of exacerbations. In contrast to the conflicting results of the current literature, the evaluation of our structured education programme for patients with mild to moderate COPD revealed a significant improvement of inhalation technique and self-control of the disease as well as a significant reduction of exacerbations. Therefore, it may be concluded that education may modify the behaviour of patients in the management of COPD by improving self-control and self-management of the disease and thus reducing morbidity.

[Evaluation of a structured education programme for patients with COPD under outpatient conditions-- a pilot study]. / Evaluation eines ambulanten strukturierten Schulungsprogramms für Patienten mit COPD--eine Pilotstudie.

In contrast to other chronic diseases, such as bronchial asthma, the role of patient education in the management of COPD still remains unclear. Therefore, we evaluated the efficacy of a structured education programme for COPD-patients under outpatient conditions in a prospective pilot study including 21 patients with mild to moderate COPD over a period of two years. The main teaching items of the programme are: self-control of the disease with regular peak flow measurements, the observation of typical symptoms and the patients diary, effects and side effects of the medication, correct inhalation technique and the patients' ability to change the medication with respect to the actual degree of airflow limitation. The frequency of episodes of dyspnoea per day was significantly reduced after the first year. Before the training course the patients had an average of 1.6 +/- 0.5 episodes of dyspnoea per day, after the first year 1.0 +/- 0.5 (p < 0.05). With respect to the year before the intervention, the total number of the exacerbations did not change significantly in the two years after the participation in the programme, but the number of self-managed exacerbations increased. Further effects were an improvement of the knowledge of the patients about the effects and side effects of the medication: before the education the number of correct answers in a multiple choice test was 9.1%, one year later 68.7% (p < 0.01) and after the second year 70.5% (p < 0.01). The self-control of the disease could be improved by regular observation of symptoms, peak flow measurements and patients' diary. The number of hospital days due to the diagnosis COPD decreased from 10.1 +/- 0.5 days per patient and year to 2.1 +/- 0.2 days (p < 0.01) in the first year after the education and remained constant with 2.4 +/- 0.6 days (p < 0.01) even in the second year after the course. The efficacy of the education programme is still evident two years after the training. In comparison to the results one year after the programme we found a loss of efficacy in some aspects, particularly in the self-control of the disease. In conclusion, structured education programmes under outpatient conditions could improve the self management abilities in patients with mild to moderate COPD. Randomized controlled trials with a larger sample size are needed to confirm the results of this pilot study.

[Evaluation of a structured education program for adult outpatient asthmatics]. / Evaluation eines ambulanten strukturierten Asthma-Schulungsprogramms für Erwachsene. Eine Pilotstudie.

BACKGROUND AND METHODS: The efficacy of a structured education programme (AFAS) unter outpatient conditions was evaluated in a pilot study including 25 mild to severely ill adult asthmatics (age 41 +/- 2 yrs.) over a period of two and a half years. The main teaching items of the programme are: self-control of the disease with regular peak flow measurements, monitoring of symptoms with a patient diary, effects and side effects of the treatment, correct inhalation technique of asthma medication and the ability of self-management with regard to the actual degree of airflow limitation by the patients. RESULTS: After AFAS the knowledge of the patients regarding the disease as well as the medication increased significantly. There was an improvement of drug therapy: before AFAS only 52% of the patients used inhaled steroids on a regular basis with regard to 96% one and two years after participation of AFAS (p < 0.01). The self-control of the disease was improved: before AFAS no patient measured peak flow during acute dyspnoea, compared with 88% (p < 0.001) and 75% (p < 0.001) one and two years after AFAS, respectively. The number of severe asthma-attacks decreased significantly from 10.7 +/- 2.5 per patient and year before education to 1.3 +/- 0.2 (p < 0.001) after the first year and to 2.0 +/- 0.3 (p < 0.05) after the second year. The total number of hospital days due to asthma decreased from 219 days in the year before the participation in AFAS to zero (p < 0.001) in the first year after the education and to 17 days (p < 0.001) after the second year. CONCLUSIONS: The efficacy of patient education with AFAS is still evident two years after the course, but a reduction of self-control of the disease was observed during the follow-up period. In conclusion, structured education programmes for adult asthmatics can be effective even under outpatient conditions.

[Noninvasive ventilation in the acute care hospital--a cost factor?]. / Nichtinvasive Beatmung im Akutkrankenhaus--ein Kostenfaktor?

BACKGROUND: Noninvasive ventilation as well established in treatment of chronic respiratory failure. Many announcements and our own experience give evidence that this method of treatment is useful for patients with acute respiratory failure too. Also the actual situation of our health system requires increasing attention to financial points of view. PATIENTS AND METHOD: We analyzed a number of 185 patients who needed mechanical ventilation in our intensive care unit in 1995. 80 of these 185 needed mechanical ventilation due to pulmonary and cardiopulmonary diseases (e. g. cardiac failure, exacerbation of chronic obstructive lung disease, pneumonia and status asthmaticus). 61 received invasive, 19 noninvasive ventilation. RESULTS: Nineteen of 61 patients with invasive and 1 of 19 with noninvasive ventilation died. The mean duration of ventilation was 8.9 (1-50) days in the invasive ventilated group and 2.9 (1-8) days in the noninvasive ventilated group. A cost reduction of nearly 10000 Marks per patient can be calculated, using noninvasive ventilation due to the shorter duration of treatment. CONCLUSION: So noninvasive ventilation is a cost reducing and gentle alternative compared to conventional invasive mechanical ventilation for many patients with acute respiratory failure. It is also practicable in regional hospitals. Further investigation is needed to specify those groups of patients who receive the most benefit from noninvasive ventilation.