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How to improve asthma patient outcomes using spaced education


Cover of "Living with Asthma"

Cover of Living with Asthma

There had been no plans to make this content public, but I thought I’d share it because of my interesting realisation that the Zemanta search tool may be  a reasonably valid way to winkle out papers relevant to a topic of interest. Out of habit it now I offer link to further content that on first appearances seems to  offer similar or contrasting views. Before I look at the selection that was offered to me, and the 7 from the 16 or so I was offered I am going to go through conventional route using the Open University Online Library and see what I may find that to any large extent differs.

I am not a physician or Medical Docotor, though I am asthmatic and have been in, on and off a variety of inhalers and sometimes oral steroids for some thirty years.

Preventer – Inhaled Steroid – two puffs twice a day. Used with a spacer to reduce chances of thrush.

Reliever – as needed, which is generally never, with rare need if I develop a chest infection, in which case I may end up on antibiotics anyway.

Oral Steroids – Very rarely, usually related to a chest infection. Once every five years?

Nebulizer – Never. Unlike my late father and one (or two) relations who take the view that they only need the preventer when they are wheezy … and end up hospitalised when they have an asthma attack and in the case of my father on steroids for so long that he became diabetic.

Preventative measures – know your triggers, avoid them, keep fit and attend an annual Asthma Clinic. I have to be cautious with house dust allergy and its partner in crime – damp. The odd list of triggers includes, at times, bleach, cumin seeds, one of the Lucozade sports drinks (odd that, coming from GSK who also produce asthma drugs). Possibly white flour. Yeast causes other problems too. We have a dog, but I’m not comfortable for long in a house with soft furnishings where there are cats. Get the bedroom windows open as often as possible. Use a specialist vacuum cleaner on the mattress, pillows and duvet. No carpets. No curtain. Leather sofa preferred.

Fig. 1. Twenty years ago I found myself producing, directing and writing a two information videos for a major pharmaceutical company – ‘Living with Asthma’ and ‘the Cost of Asthma’.

These had a shelf life of some ten to fifteen years, eventually to be replaced by DVD and online interactive equivalents. We did a combination of narrative drama reconstruction – a thread from a TV soap  in which a protagonist has an asthma attack, interviews with patients and experts (doctors and pharma) and narration with 3D animations and charts.

The purpose of this exercise is to:

  • Justify and explain the question for a piece of empirical research.
  • Offer FIVE pieces that  support then set you research on its way.
Though an academic exercise I’m going to treat this as something that could find funding, and that I could carry out.
What is the proposed research about? Asthma patient ignorance of best practice in relation to taking their prescribe drugs – why they are taking the drugs, how they work, when they should take them, how and how often …
What is it trying to find out or achieve? Improve patient care i.e. compliance (UK) – so taking their medicine correctly. This is important where the condition is chronic and the symptoms aren’t continuous. People tend to lapse taking the preventative drugs … it takes several days on onset of symptoms for these to kick in.
How will it go about doing that? A randomised controlled trial in which all asthmatics are invited to sign up to receive information over a period of x months, reminders about asthma and their drug taking regime.
What will we learn from it and why was it worth learning? That a significant percentage of asthmatics who have been prescribed an inhaled steroid (preventer medicine) to take twice daily are failing to do so, simply because they don’t see the need to do so unless they are feeling wheezy (a misconception, it should be taken regardless) or they allow their inhalers to run on empty for some time before being aware of this.That a significant percentage of asthmatics, probably largely the same group as above, misuse their reliever inhaler a) taking it too often b) not correctly inhaling so that drug ends up lining their mouth rather than entering their lungs.Taking the right dosage of inhaled steroid, as prescribed, in the correct manner, is likely to reduce need for the reliever inhaler to nil and will result in less long term damage being done to the lining of the lungs.It will improve patient outcomes, reduce the use of inhibitors and reduce hospital visits or overnights where a person has suffered an avoidable asthma attack.

 

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