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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.



How far can we push the boundaries of e-learning? Is there a future for extreme-learning?

Fig.1. Using scanning a doctor communicates with Scott Routley  who has been in a coma for over ten years (BBC, 2012)

Vegetative patient Scott Routley says ‘I’m not in pain’

Using scanning a doctor communicates with Scott Routley who has been in a coma for over ten years (BBC, 2012)

Invaluable to this patient but opening all kinds of possibilities in relation to responding to a stimulus through thought alone.

If this patient ‘learns’ how to communicate further than this surely is technology enhanced learning on the very out fringes of the extreme. In practice an engineer might describe this as ‘testing to destruction’ – lessons are learnt from such cases.

See more on Panorama http://www.bbc.co.uk/programmes/b01ny377

Asked to think about the future of learning and for disabled students in particular, I couldn’t help but consider the most extreme forms of e-learning with severely disabled patients – those beyond our reach the ‘brain dead’ while those in a vegetative state coming within reach – and is this state is one we go into under general anaesthetic, one from which a person does occasionally recover.

Fig.2. A new brain scanner helps completely paralysed people to spell words

I don’t want to be a guinea-pig in such a set up, but what if having been kept ‘alive’ say after a car accident I tell those who have stirred me to communicate that I wish I had died on the roadside all those years ago? Do they remove the technology and well me into a side room until I die of natural causes decades later? (This was the scenario in a black and white ante-war movie of the 1930s … I think. Recall the detail of the film and would love its name if you know it).

I don’t mean to be flippant, but could this technology be used to talk with animals … or give us the sense that we are ? If attached to such devices in our sleep, might dream actions be turned into real ones?

Fig.3. Real-life Jedi: Pushing the limits of mind control (BBC 2012) Last accessed 10 Dec 2012


And who gets there hands on this extremely expensive kit? Anyone willing to be a guinea-pig? The children of billionaires? Or in time – everyone with a need.

If in your 90s you are reduced to this state could you or would you want to extend life if it could be enriched in this way? Pushing humans into a stage that is more than just one foot in the grave – you are, in every sense, living as if buried alive? And if this could be realistically be sustained for decades?

Depends on the person I suppose.

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