Consultations for asthma: will greater patient involvement deliver better health?

Self-management of asthma is a complicated activity, perhaps more demanding for asthma than for any other chronic illness. People with asthma are faced with an illness whose causes and fluctuations are poorly understood (witness the pages of this journal), to be controlled with an often mysterious collection of inhalers. Our increasingly high expectations of patients’ abilities to self-care are fuelled by trials in selected populations¹ and politicians with visions of reduced healthcare costs.^2,3 The realities of asthma self-management are often scepticism and low uptake.⁴ The consultation remains the most important opportunity for helping patients to develop the ability to manage their asthma. Rightly, the consultation continues to be subject to a range of critical perspectives.

Social scientists offer a number of deficiencies that hinder success in promoting self-care: the infrequency with which doctors seek and patients air fears about medication and side effects, lack of opportunity for patient involvement in treatment decisions, lack of recognition of the coexistence of lay and popular remedies. We stand accused of an enthusiasm for authoritarian, positivist, illness centred medicine.^5,6–10 Ethicists show how …