Asthma Health Outcomes Project
Overviews of Surveyed Asthma ProgramsSeptember 2005
International Programs: China (cont’d)
Evaluation of the Efficacy of a Hospital-Based Asthma Education Programme in Patients of Low Socioeconomic Status in Hong Kong
Hong Kong SAR China
Good asthma control requires optimal medical treatment in conjunction with appropriate self-
management. In the West, the effectiveness of patient education on improving self-management has been well documented. However, data amongst Asian populations are lacking. The authors performed a pilot study to evaluate the efficacy of a hospital-based education program aimed at improving self-management skills and reducing morbidity in a Chinese population with low socioeconomic status and education level.
The education program was a low-cost program conducted by respiratory nurse specialists. Patients attending the asthma clinic were instructed during a two-hour educational session on asthma pathophysiology, its potential triggers, the appropriate use of medications including proper inhaler techniques, and the self-management of their disease. These instructions were reinforced by video sessions at subsequent outpatient clinic visits when patients' inhaler and peak flow techniques were checked by the same nurses and their self-management plan re-examined by the attending physicians. Asthma knowledge, inhaler technique, FEV1 and peak expiratory flow (PEF), and patients' self-rating of their asthma were determined at baseline, 6 months and 1 year after the intervention. Morbidity was assessed by the numbers of hospitalizations, unscheduled visits to family physicians and accident and emergency department attendance, courses of oral steroid used and days off work or school at and 1 year.
Two hundred and thirty patients were recruited for the study, 83% completing the entire assessment period. The group demonstrated significant improvements in lung function: the mean FEV1 +/- SD increased from 63.6 +/- 20.6% of predicted values at baseline to 68.5 +/- 22.3% at 6 months and 68.6 +/- 22.8% at 1 year (P < 0.05), and the mean PEF +/- SD increased from 64.6 +/- 23.0% of predicted values at baseline to 75.4 +/- 27.0% at 6 months and 76.8 +/- 24.5% at 1 year (P < 0.001). There were also significant improvements in inhaler technique (P < 0.01), asthma knowledge (P < 0.001), patients' self-rating of their asthma (P < 0.05), and reductions in the numbers of hospitalizations (P < 0.01), visits to family physicians (P < 0.001) and accident and emergency department attendance (P < 0.001) during the study period. Patients with moderate to severe asthma as defined by an FEV1 of < 80% of predicted values were most likely to benefit from the program.
In conclusion patient education is likely to be an essential component in the holistic approach to the asthma management even amongst Asian populations of low socioeconomic status and education level. Further studies using randomized controlled trials are necessary to consolidate these findings.
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