Asthma morbidity 6 yrs after an effective asthma self-management programmein a Maori community

A 6-month Maori community-based asthma self-management programme, involving a "credit card" asthma self-management plan, has previously been shown to be an effective and acceptable system for reducing asthma morbidity. The effectiveness of the asthma self-management programme and participants' selfmanagement behaviour was assessed 6 yrs after the formal end of the pr ogramme. Participants were surveyed at the time of enrolment, and 1, 2, and 6 yrs af ter completing the programme. In each survey, participants were questioned on markers of asthma morbidity and use of medical services during the previ ous 12 months, Selfmanagement behaviour was assessed using a questionnaire at 2 years and 6 yrs. Of the 69 original participants, 47 (68%) were surveyed after 6 yrs, They g enerally had reduced severe asthma morbidity and emergency use of health se rvices from baseline. In particular, the proportion who had an emergency vi sit to a general practitioner had decreased from 41% to 18% (p=0.02). Howev er, the percentage of nights woken due to asthma had returned to preinterve ntion Levels, and the proportion of participants taking prescribed regular inhaled steroid had decreased from 91% to 53% (p<0.001). Compared with 2 yr s after completion of the asthma programme, self-management behaviour had a lso deteriorated, with 29% versus 73% (p<0.001) using their peak flow meter daily when their asthma was "getting bad" and 41% versus 86% (p<0.001) usi ng the "credit card" plan to increase the amount of inhaled steroids in the last year. Although the programme participants were still experiencing reduced morbidi ty from their asthma 6 yrs after the end of the self-management programme, the benefits were less than those observed at 2 yrs, These findings suggest that under-recognition and under-treatment of asthma with appropriate amou nts of inhaled steroids is a major factor contributing to asthma morbidity in this indigenous rural community. To obtain enduring benefits from a self -management system of care continued reinforcement of self-management skill s seems to be an essential component of any follow-up.