DELIVERING ASTHMA EDUCATION TO SPECIAL HIGH-RISK GROUPS

Patients at high risk from their asthma and therefore worthy of more f ocused asthma education are those at risk of fatal and near fatal asth ma(NFA). In recent years the characteristics of these patients have be en better defined. The most important risk factor appears to be a prio r history of NFA. Other important features include prior emergency roo m visits or hospitalization for asthma. Excess use of beta-agonists, e specially in the absence of inhaled corticosteroids, also confers incr eased risk. High risk groups also share similar psychosocial barriers as well as economic deprivation. The benefits of asthma education in t hese groups have been assessed in a number of studies. In general, ast hma education has been shown to have an impact on these patients. Grea ter effects have been achieved where there has been consistent follow- up by the same physician. Patients require frequent reinforcement of t heir asthma management, especially regarding their response to acute e xacerbations. A sub-group of patients with more severe asthma appear t o have a problem perceiving dyspnoea and may therefore benefit from pe ak flow monitoring but the problem of compliance with this interventio n is significant. Behaviour modification plays an important role as do es ensuring the patient has adequate resources to purchase medications especially the more expensive anti-inflammatory therapy. Future studi es should focus on optimizing the potential benefits of educating high risk patients as they are not only those at greatest risk of death bu t also consume a disproportionate amount of health care resources. (C) 1997 Elsevier Science Ireland Ltd.