Chest
Volume 107, Issue 4, April 1995, Pages 1003-1008
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Clinical Investigations: Asthma
Self-Management, Autonomy, and Quality of Life in Asthma

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Study objective

Asthma management guidelines emphasize increased autonomy for asthmatics through patient education and patient-initiated action plans. The aim of this study was to examine autonomy, as reflected in the preferences of asthmatic subjects for decision making and their preferences for information seeking. The results were related to quality of life in asthma.

Subjects

One hundred twenty-three adults with asthma.

Design

Questionnaire-based cross-sectional analytic survey.

Setting

Eighty-five subjects were recruited from community pharmacies at the point of sale of albuterol inhalers for asthma and compared with 38 subjects recently hospitalized for acute severe asthma.

Measurements

Asthma-related quality of life, autonomy preferences questionnaire.

Results

The subjects in both groups had a mild-to-moderate quality of life impairment in all domains that was greater in the posthospitalization group (p<0.05). Both groups expressed strong preferences for information concerning their condition (92se 0.8, 91se 1.1, out of a possible 100). Subjects did not prefer to make decisions alone about the management of asthma exacerbations (51.0se 1.2, 52.5 se2.0, out of a possible 100). As the severity of the asthma exacerbation increased, the desire to make decisions decreased (p<0.05). Older subjects expressed less desire for decision making than younger subjects. Self-management autonomy was not correlated with quality of life in asthma.

Conclusions

We conclude that while asthmatics have strong desires to be informed about their illness, they do not wish to be the prime decision makers during an exacerbation. These findings have implications for the success of self-management programs and action plans.

Section snippets

Subjects

Two groups of adult asthmatic subjects were studied. The first group comprised a community sample of 135 asthmatics who were recruited from retail pharmacies when they purchased inhaled albuterol for treatment of asthma. These subjects participated in an earlier study7 and were contacted by mail to participate in the current study. The second group of 38 asthmatics were contacted 8 weeks following hospital admission for acute asthma as part of an audit of asthma care at the John Hunter Hospital.

Results

Completed questionnaires were returned by 85 of the 133 subjects in the community group (response rate, 64%) and 38 the 58 patients who were contacted 8 to 12 weeks after hospital discharge for acute severe asthma (response rate, 65%).

Subjects in the community group reported mild quality of life impairment due to asthma in each of the four domains and in overall quality of life (Table 1). There was significantly greater quality of life impairment in the group who had recently been hospitalized.

DISCUSSION

This study was performed to measure patients’ wishes for autonomy in asthma, specifically focusing on patient preferences for information about the condition and for decision making during an asthma exacerbation. We also sought to measure quality of life in adults with asthma and relate this to self-management autonomy. The results show that there is mild to moderate quality of life impairment in ambulatory patients with asthma. Subjects expressed strong preferences for information about their

Acknowledgment

The authors thank Gaye Sheather for her secretarial assistance. The Year 2 Population Medicine Group 91C of the Faculty of Medicine, Newcastle University, consisted of Y. Antill, J. Broughton, J. Dowling, L. Grinham, E. Jordan, M. Newton, J. Sullivan, C. Spooner, and A. Watts.

References (19)

  • SearsMR et al.

    Patients at risk of dying from asthma: New Zealand experience

    J Allergy Clin Immunol

    (1987)
  • WoolcockAJ et al.

    Asthma management plan—1989

    Med J Aust

    (1989)
  • BrodyH

    Autonomy revisited: progress in medical ethics

    JR Soc Med

    (1985)
  • ThomasmaDC

    Autonomy in the doctor-patient relationship

    Theor Med

    (1984)
  • GreenfieldS et al.

    Patients’ participation in medical care: effects on blood sugar control and quality of life in diabetes

    J Gen Intern Med

    (1988)
  • FriesJF et al.

    Reducing health-care costs by reducing the need and demand for medical services

    N Engl J Med

    (1993)
  • GibsonPG et al.

    Association between availability of nonprescription ß2-agonist inhalers and undertreatment of asthma

    BMJ

    (1993)
  • GibsonPG et al.

    A prospective audit of asthma management following emergency asthma treatment at a teaching hospital

    Med J Aust

    (1993)
  • BaumanA et al.

    Asthma morbidity in Australia: an epidemiological study

    Med J Aust

    (1992)
There are more references available in the full text version of this article.

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Supported in part by a student scholarship from the Asthma Foundation of NSW.

revision accepted August 12.

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