ASSESSMENT OF PRACTICAL KNOWLEDGE OF SELF-MANAGEMENT OF ACUTE ASTHMA

Aims: To develop an instrument for the measurement of, and to determin e the level of, practical knowledge of self-management of acute asthma . Methods: Eighty patients with moderate/severe asthma attending a hos pital-based asthma clinic responded to an interviewer-administered que stionnaire. Subjects were asked to describe the action they would take in response to each of two hypothetical evolving attacks: (1) one of gradually increasing severity and (2) the other developing rapidly. Re sponses were scored according to the appropriateness of actions taken relevant to the stage of the attack. Transcripts of the responses were scored independently by three of the investigators according to a sys tem based on Thoracic Society of Australia and New Zealand (TSANZ) and British Thoracic Society (BTS) consensus statements on asthma managem ent. A 25-point scale was used on which 0 represented a total lack of appropriate responses and a score of 25 was an optimal response. Resul ts: Interrater and intrarater reliability were excellent. Mean (+/-SD) scores for the slow and rapid onset attacks were 12.8+/-4.0 and 13.9/-4.8, respectively. The scores for the two scenarios were predicted b y each other (p=0.002) and by the interviewer's rating of asthma manag ement knowledge (p=0.0004, p=0.0001), but not by age, sex, race, previ ous asthma morbidity, depression, or anxiety. In both scenarios, most patients indicated that they would increase inhaled p-agonist (85% for slow-onset scenarios and 94% for rapid-onset scenarios, respectively) and use their action plan and/or seek urgent medical advice at an app ropriate time (74% and 70%). Although some would measure peak expirato ry now (PEF) initially (54% and 30%), only a minority would continue t o monitor PEF in the context of worsening acute asthma (30% and 24%). When a severe life-threatening situation was described, only 50% and 6 4%, respectively, indicated that they would call emergency services. C onclusions: Scenarios describing hypothetical asthma attacks are a use ful and reproducible method of assessing practical knowledge of self-m anagement of acute asthma. Patients presented with scenarios frequentl y made errors in their hypothetical responses. The errors made with sc enarios, which parallel errors reported in real clinical situations, o ccurred despite the fact that this patient population had received con siderable education and training about how to manage asthma. Most indi cated they would not monitor PEF even in an exacerbation of asthma and would not call emergency services despite life-threatening asthma. Th ese scenarios may allow us to explore the gap between knowledge about treatment and actual practice, and perhaps to help close that gap and thus reduce asthma morbidity and mortality.