Commentary: Self-management programs in the treatment of asthma.
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Asthma↗
Biomedical subjects
H Kotses
Publications and source records attributed to H Kotses.
Highlights of the annual meeting of the International Society for the Advancement of Respiratory Psychophysiology and the 14th International Symposium on Respiratory Psychophysiology.
This article provides a review of selected presentations and events that highlighted the annual meeting of the International Society for the Advancement of Respiratory Psychophysiology (ISARP) and the 14th International Symposium on Respiratory Psychophysiology, Toronto, Ontario, Canada, October 1995. The meeting, which was scheduled as a satellite to the 35th annual meeting of the Society for Psychophysiological Research, included two workshops (Diana M. Innocenti on "Identification of Individual Breathing Patterns and Introduction to the Reeducation of Dysfunctional Patterns in Hyperventilation, Asthma, and Emphysema" and Richard N. Gevirtz on "Respiratory and Psychophysiological Factors in the Diagnosis and Treatment of Functional Cardiac and Panic Disorders"), two symposia (one on "Breathing Retraining: Issues and Applications" and one on "Capnography and Hyperventilatory Hemodynamics"), three invited addresses (Hans Folgering on "Rehabilitation of Patients with Exercise Hypoxemia"; David Stubbing on "Assessing Impairment, Disability, and Handicap in Chronic Lung Disease"; and Robert Banzett on "Hypercapnia-Induced Air Hunger"), three panel sessions (one on "Respiratory Psychophysiology of Airway Obstruction," one on "Applied Respiratory Psychophysiology," and one on "Hyperventilation and Panic: Psychological Aspects"), and a poster session.
Congresses as Topic↗
Evaluation of individualized asthma self-management programs.
We compared the effectiveness of personalized asthma self-management recommendations with that of a group self-management program. We assigned each of 34 asthma patients randomly to one of three conditions: individualized asthma self-management, group asthma self-management, and control. We derived individualized self-management recommendations from patient recordings of asthma occurrence, asthma precipitants, and peak expiratory flow rate made during a 3-month period. The group program we used was the Wheezers Anonymous program. As compared to a control group of patients who received no self-management training, the patients in both the individualized and group condition evidenced improvement of pulmonary function, as measured daily with a home peak flow meter. The improvement was equivalent for patients in the two conditions. Patients in the individualized condition also exhibited a drop in frequency of asthma attacks, but patients in the group condition did not. We concluded that individualized asthma self-management is effective in reducing symptoms of asthma.
Adult↗
A self-management program for adult asthma. Part II: Cost-benefit analysis.
BACKGROUND: We performed a cost-benefit analysis of a previously described self-management program for adult asthma. METHODS: Direct and indirect cost data from 47 subjects who participated in the self-management program were analyzed. In particular, costs incurred by the subjects 1 year before participation were compared with costs incurred 1 year after participation. RESULTS: The cost-benefit analysis indicated that the program was beneficial, reducing the cost of asthma to each patient by $475.29. The benefit came primarily from reductions in hospital admissions (reduced from $18,488 to $1538) and income lost as a result of asthma (reduced from $11,593 to $4589). The asthma self-management program cost $208.33 per patient. Comparison of the program cost with the program benefit produced a 1:2.28 cost-benefit ratio, demonstrating that the program more than paid for itself. CONCLUSION: A self-management program for adult asthma effectively reduced the cost associated with asthma. The findings are especially salient because the subjects' asthma was generally under good medical control when they participated in the program. The savings were therefore not the result of improved medical treatment; medical treatment was a controlled parameter, not a variable, in the self-management study. The self-management program for adult asthma was cost-beneficial.
Adult↗
A self-management program for adult asthma. Part I: Development and evaluation.
BACKGROUND: We developed and evaluated a self-management program for adult asthma. In developing the program, we considered questions of format and behavior control. The format we selected included components known to be effective in educational settings. We regulated asthma management behavior through the introduction of environmental cues. METHODS: Seventy-six subjects, whose asthma was generally under medical control, were assigned randomly to either a treatment group or a waiting-list control group. Those in the treatment group were exposed to a 7-week program that incorporated proven features of providing effective training and establishing behavioral control. Subsequently, subjects in the control group received the treatment. Short-term evaluation of the treatment was made after the subjects in the experimental group were trained but before the control subjects were trained. Long-term evaluation was conducted after both groups of subjects were trained. RESULTS: Over the short term, self-management training led to fewer asthma symptoms and physician visits and improvement in asthma management skills and cognitive abilities. Over the long term, self-management training was related to lower asthma attack frequency, reduced medication use, improvement in cognitive measures, and increased use of self-management skills. CONCLUSIONS: The program improved asthma management in patients whose conditions were already under good medical control. The effects of the program were apparent a year after the conclusion of self-management training.
Adult↗
Improving recognition of respiratory sensations in healthy adults.
In two discrimination training studies, we noted improvements in the ability of healthy individuals to discriminate between respiratory sensations. We trained individuals to discriminate between respiratory sensations elicited during inspiration in Experiment 1 and during expiration in Experiment 2. We elicited respiratory sensations by having participants breathe through circuits that differed in their resistance to air flow. Training, in both experiments, was conducted within the context of a task in which individuals judged which member of a series of respiratory circuit pairs was easier to breathe through. To improve the accuracy of judgments, we gave participants feedback of their performance, and we faded air flow resistance. The latter procedure consisted of presenting circuit pairs in order of increasing similarity. Individuals who received performance feedback with fading of air flow resistance demonstrated reliable improvements in discrimination from pre- to posttraining in both experiments, but controls, who received either performance feedback or practice in discrimination did not. These findings may contribute to improving awareness of respiratory sensations in asthma patients, and thereby bolster efforts to manage asthma.
Adolescent↗
The Knowledge, Attitude, and Self-Efficacy Asthma Questionnaire.
The Knowledge, Attitude, and Self-Efficacy Asthma Questionnaire (KASE-AQ) is a paper-and-pencil instrument that was developed to allow physicians, behavioral scientists, and other health care personnel to assess asthma patients' knowledge regarding asthma, their attitudes about their asthma (including their willingness to cooperate with the physician in managing asthma), and their self-efficacy regarding their perceived ability to control the disorder. The KASE-AQ assesses changes in these patient variables following a particular intervention. The KASE-AQ proved to be reliable and internally consistent, and a factor analysis revealed presence of three subscales in the questionnaire (knowledge, attitude, and self-efficacy about asthma). Following asthma education and self-management training, experimental group subjects showed significant improvements in knowledge, attitude, and self-efficacy. Waiting-list control subjects showed similar improvements following training. Both groups' scores at 3-month follow-up remained significantly higher than their baseline scores on all 3 variables.
Adult↗
A life activities questionnaire for childhood asthma.
The paper describes the development and testing of a paper-and-pencil instrument, the Life Activities Questionnaire for Childhood Asthma, that can be applied to assess activity restriction in children with asthma. It describes how items for the instrument were selected to ensure the validity of the developed instrument. The method by which the reliability of the questionnaire was established is also discussed. The result is a valid and reliable instrument that should have wide applicability in measuring activity restriction because of childhood asthma. The developed instrument has potential use in clinical settings, research, and policy making.
Activities of Daily Living↗
EMG stability as a biofeedback control.
Factors that may confound comparisons between electromyographic (EMG) biofeedback training and its control conditions include feedback quality and experience of success. We investigated the usefulness of a control procedure designed to overcome these potential sources of confounding. The procedure consisted of training muscle tension stability. We used it as a control for frontal EMG relaxation training in children with asthma. To equate the groups for feedback quality and experience of success, we gave each child in the control condition audio feedback decreasing in pitch when muscle tension was at or near baseline levels, and feedback increasing in pitch when muscle tension was either substantially above or below baseline levels. Children in both groups were instructed to decrease the pitch of the tone. In comparison to children in the relaxation condition, the children in the control condition exhibited stable levels of muscle tension throughout eight training sessions. We concluded that feedback for stable muscle tension may be a useful control procedure for EMG biofeedback training whenever experimental and control procedures differ in either feedback quality of degree to which they permit subjects to experience success.
Adolescent↗
A life activities questionnaire for adult asthma.
The development, testing, and applicability of an instrument, the Life Activities Questionnaire for Adult Asthma is described that can be used to assess activity restriction in adults with asthma. It explains how items for the instrument were selected to insure the validity of the developed instrument. The reliability of the questionnaire is also discussed. The result is a valid and reliable paper-and-pencil instrument that should have wide applicability as a component of quality of life measurement. This instrument has potential for functional use in clinical settings, research environments, and policy-making procedures.
Activities of Daily Living↗
Long-term effects of biofeedback-induced facial relaxation on measures of asthma severity in children.
We studied the effects of electromyographic biofeedback on measures of asthma severity in children. Fifteen children received biofeedback training to reduce facial tension, and 14 children, who served as controls, received biofeedback training to maintain facial tension at a stable level. Assignment to experimental condition was random. As a result of training, electromyographic levels decreased in children trained in facial relaxation and remained fairly constant in children trained in facial tension stability. Biofeedback training was augmented for children in both groups by having them practice their facial exercises at home. Each child's condition was followed for a five-month period subsequent to biofeedback training. Throughout the experiment, the following measures of asthma severity were monitored: lung function, self-rated asthma severity, medication usage, and frequency of asthma attacks. In addition, standardized measures of attitudes toward asthma, self-concept, and chronic anxiety were recorded at regular intervals. As compared to the facial stability subjects, the facial relaxation subjects exhibited higher pulmonary scores, more positive attitudes toward asthma, and lower chronic anxiety during the follow-up period. Subjects in the two groups, however, did not differ on self-rated asthma severity, medication usage, frequency of asthma attacks, or self-concept. Based on the improvements we observed in pulmonary, attitude, and anxiety measures, we concluded that biofeedback training for facial relaxation contributes to the self-control of asthma and would be a valuable addition to asthma self-management programs.
Adolescent↗
The COPD Self-Efficacy Scale.
Many individuals with COPD develop a lack of confidence regarding their ability to avoid breathing difficulty while participating in certain activities, however minimal the physical demands of the activity may be. This lack of confidence may be expressed as low self-efficacy. As a result of low self-efficacy, COPD patients may refrain from many routine activities of daily living. Identifying situations in which individuals with COPD experience low self-efficacy would allow the development of specific treatment interventions designed to increase the patient's self-efficacy in those situations and consequently increase activity. We developed a 34-item COPD Self-Efficacy Scale (CSES) to assess self-efficacy in individuals afflicted with COPD. The CSES has good test-retest reliability (r = .77), excellent internal consistency (Cronbach's alpha = .95), and a five-factor structure (negative affect, intense emotional arousal, physical exertion, weather/environmental, and behavioral risk factors.
Activities of Daily Living↗
Predicting asthma in individual patients.
The degree to which asthma attacks were related to seven environmental variables was determined for each of 17 individuals. Using stepwise regression procedures, cladosporium mold, ragweed pollen, and a change in temperature were significant predictors of asthma attacks in 5 of 17 individuals. The information provided by these analyses could prove useful in helping some individuals manage their asthma.
Adult↗
Individualized asthma self-management: a beginning.
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Asthma↗
Prediction of asthma episodes in children using peak expiratory flow rates, medication compliance, and exercise data.
Asthmatic patients demonstrate considerable variation in the extent to which their subjective evaluations and objective measures of airways obstruction correspond. The detection and prediction of asthma episodes have been improved through the use of objective pulmonary measures, such as peak expiratory flow rate (PEFR). Furthermore, information regarding adherence to medication regimens and specific asthma triggers (ie, exercise) may also improve the predictability of asthma in children. The utility of using PEFR values, medication compliance information, and exercise data for the prediction of asthma episodes in individual children was investigated in the present study. Individual logistic regression equations were calculated for ten asthmatic children. In predicting asthma episodes, PEFR was present in the model for nine out of ten subjects; exercise was included for two out of five subjects providing such data; whether an attack had occurred in the preceding 12-hour period was predictive for one out of ten participants; and whether an attack had been experienced in the previous 24 hours was present for four out of ten subjects. Hosmer-Lemeshow values indicated that the models fit the data well for nine subjects (alpha greater than .05). The mean model prediction rate (80.85%) was higher than the mean base rate (75.72%). The relative risk ratio values ranged from 0 to 5.72, with a mean of 3.50. These results suggest that the prediction of episodes may be enhanced by using PEFR, exercise, and time of day.
Adolescent↗
Habituation of phasic total respiratory resistance responses.
We examined the effects of repetitious stimulation on phasic respiratory resistance responses of 30 healthy adult males. Individuals were told either that they would inhale a substance which would cause bronchoconstriction or that they would inhale a substance which would cause no breathing changes. All subjects completed four inhalation trials. During each trial a lamp was turned on to indicate the presence of the inhalant; in reality, the subjects inhaled no substances. Respiratory resistance and functional residual capacity were measured just before and during the time the lamp was on. Regardless of the type of instruction, the response to the inhalation task was predominantly an increase in respiratory resistance. During Trials 1, 2, and 3, the number of subjects who increased respiratory resistance was greater than the number of subjects who decreased respiratory resistance. The number of subjects who increased respiratory resistance was not different from the number of subjects who decreased respiratory resistance during Trial 4. Changes in functional residual capacity did not affect changes in respiratory resistance; functional residual capacity changed neither within nor between trials. Given a progressive decrease in the number of subjects who increased their respiratory resistance on successive trials, the results were consistent with a response habituation model.
Adolescent↗
Environmental control of asthma self-management.
We describe a model of asthma self-management based on environmental control of behavior. The model emphasizes aspects of the environment that either prompt or strengthen asthma self-management behavior. In prompting behavior, environmental events function as behavioral cues; in strengthening behavior, they represent reinforcers. We describe concepts related to cueing and reinforcement, and how these operations might be incorporated in individualized self-management programs. Finally, we discuss evidence supporting asthma self-management programs based on environmental control behavior.
Asthma↗
The Revised Asthma Problem Behavior Checklist.
The Asthma Problem Behavior Checklist (APBC) has proved to be an accurate and invaluable instrument for pinpointing potential behavioral problems in children with the disorder. This article presents the Revised Asthma Problem Behavior Checklist (RAPBC). The value of the RAPBC is that: (a) it has proven reliability when tested with asthmatic adults; (b) the change from a dichotomous yes/no format, used in the APBC, to a 5-point Likert-type answer format adds greater sensitivity to the instrument; and (c) data gathered with the RAPBC compare favorably to information gathered in two previous studies with the APBC. Considering the reliability and validity of the RAPBC, it should prove useful in both clinical and research settings.
Adolescent↗