Impact of patient education and self-management on morbidity in asthmaticsand patients with chronic obstructive pulmonary disease

The effect of patient education on morbidity in asthmatics and COPD patient s has not previously been investigated in a single study. We randomized 78 asthmatics and 62 COPD patients after ordinary outpatient management. Intervention consisted of educational group sessions and indivi dual sessions administered by a trained nurse and physiotherapist. A self-m anagement plan was developed. The utilization of health resources and absen teeism from work was self-reported monthly, During the 12-month follow-up, approximately two (P = 0.001) and three (P = 0.001) times as many uneducated asthmatics and COPD patients, respectively , visited their general practitioner (GP) compared with educated. The mean reduction in GP consultations for the educated were 73% (P<0.001) and 85% ( P<0.0001) for the asthma and COPD group, respectively, compared with uneduc ated. Fifty percent of uneducated asthmatics reported absenteeism from work compared with 24% of the educated (P=0.06). The mean reduction in days off work for the educated was 69% (P = 0.03), compared with uneducated. A posi tive correlation was observed between St George's Respiratory Questionnaire total score and number of GP visits for both the asthma and COPD group (P< 0.001). We conclude that patient education in asthmatics and COPD patients reduced the need for GP visits and kept a greater proportion of patients independen t of their GP. Patient education among asthmatics also reduced the number o f days off work and appeared to increase the proportion of patients not rep orting absenteeism from work at all. Increasing number of GP visits was cor related with decreased health-related quality of life as measured by the SG RQ for both the asthmatics and the COPD patients.