Caring for patients with asthma Teaching self management takes time

EDITOR, - The Grampian asthma study concluded that peak flow meters and self management plans offered “little clinical benefit.”1 Closer examination of the methods shows that the self management plans used by Beasley et al.2 and by us3 were not used and that the crucial ingredient of doubling the dose of inhaled steroid as the peak flow falls was not adhered to. Our recently published work confirms the importance of this step. If patients manage themselves by increasing bronchodilators only, as occurred in one arm of our study, the outcome is not as impressive.4 The self management plans of the Grampian asthma study focused on when to start oral steroids and when to seek immediate medical help. Such a plan is more suited to preventing admission and increasing doctor contact rather than reducing morbidity. It is therefore no surprise that the number of consultations with general practitioners rose in the intervention group. In our experience, consultants who tailor treatment to individual patients produce less effective self management plans than asthma nurses who follow the protocol and implement tested self management plans. Teaching patients self management skills requires an initial consultation of 45 minutes and a follow up examination one week later. Specifically designed diary cards can enhance this process.4 It usually takes patients three months before they are familiar with such plans. Patients often need to be guided through their first attack. Once the concepts have been grasped then patients require little input and quite often use their peak flow meters only during an asthma attack. Although initially time consuming, such an approach reduces morbidity and is cost effective for both patient and doctor.5 The Grampian asthma study made no mention of what efforts were made …