ASTHMA

The Coping with Asthma Study: a randomised controlled trial of a home based, nurse led psychoeducational intervention for adults at risk of adverse asthma outcomes

J R Smith¹, S Mildenhall², M J Noble³, L Shepstone¹, M Koutantji⁴, M Mugford¹, B D W Harrison^1,2

¹ School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, UK
² Department of Respiratory Medicine, Norfolk & Norwich University Hospital NHS Trust, Norwich NR4 7UY, UK
³ Acle Medical Centre, Acle, Norfolk NR13 3RA, UK
⁴ Department of Surgical Oncology and Technology, Imperial College, St Mary’s Hospital, London W2 1NY, UK

Correspondence to:
Ms J R Smith
School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, UK; j.r.smith{at}uea.ac.uk

Background: Morbidity and mortality associated with severe asthma might be reduced by interventions that address psychosocial factors contributing to adverse outcomes. A study was undertaken to assess the effectiveness of a 6 month home based psychoeducational intervention delivered by a respiratory nurse specialist for adults at risk of adverse asthma outcomes.

Methods: A pragmatic randomised controlled trial was performed in 92 adults registered with hospital or primary care asthma clinics. All had previous hospital admissions and/or were on British Thoracic Society step 4–5 treatment and had failed to attend clinic appointments or were considered to have poor adherence to other aspects of their agreed management. Patients were visited in their homes for assessment and, where appropriate, intervention. The main outcomes measured were symptom control, asthma specific quality of life, and generic health status.

Results: At the 6 month primary time point there were no significant differences between usual care and intervention groups in mean symptom control, physical functioning, or mental health scores (differences (with 95% CI) –0.35 (–1.83 to 1.13), 3.10 (–11.42 to 17.63), 0.42 (–10.22 to 11.07), respectively). Small effects on asthma specific quality of life up to 12 months (e.g. adjusted difference at 12 months 0.13 (95% CI 0.02 to 0.25)) and short term effects on generic health status, which mirrored improvements in aspects of self-care observed at the end of the intensive phase of the intervention, were apparent only from fully adjusted analyses.

Conclusions: A home based intervention provided by a nurse receiving psychological supervision may have effects on quality of life but is overall of limited long term benefit to adults at risk of adverse asthma outcomes.

Keywords: asthma; adults; psychoeducational intervention; randomised controlled trial

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