COMMUNITY-BASED ASTHMA CARE - TRIAL OF A CREDIT CARD ASTHMA SELF-MANAGEMENT PLAN

Although asthma self-management plans are widely recommended as essent ial in the long-term treatment of adult asthma, there have been few st udies examining their use. Our objective was to assess the effect of a 'credit card' adult asthma self-management plan in a community experi encing major health problems from asthma, by means of a before and aft er intervention trial of the efficacy of the ''credit card'' plan, whe n introduced through community-based asthma clinics. The participants were 69 Maori people with asthma. The 'credit card' plan consisted of written guidelines for the self-management of asthma, based on self-as sessment of asthma severity, printed on a plastic card. On one side, m anagement guidelines were based on the interpretation of peak expirato ry flow rate (PEFR) recordings, whilst the reverse side was based on s ymptoms. The outcome measures used were before and after comparison of markers of asthma morbidity and requirement for acute medical treatme nt; and a structured questionnaire assessing the acceptability and use of the credit card plan. Following the introduction of the plan, the mean PEFR increased from 347 to 389 l.min-1, the percentage of nights woken fell from 30.4 to 16.9 %, and the number of days ''out of action '' fell from 3.8 to 1.7 %. The requirements for acute medical treatmen t also fell during the intervention period. Most participants commente d favourably on the content and usefulness of the plan. In the situati on of worsening asthma, 28 % of subjects found the peak flow side of t he card most helpful, 7 % the symptoms side, and 48 % found both sides equally helpful. The credit card asthma self-management plan, when in troduced in a programme of community-based clinics, is both an effecti ve and acceptable system for self-managing asthma.