الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Asthma is a chronic respiratory heterogeneous disease characterized by chronic airway
inflammation, hyperresponsiveness to direct/ indirect stimuli and consequent narrowing that
results in episodic flare ups of wheezes, shortness of breath, chest tightness and cough that vary
over time and in intensity. It affects 1–18% of the population in different countries. Asthma
exacerbations account for significant morbidity and contribute a disproportionate amount to the
cost of asthma management. As stated in the 2007 asthma guidelines from the National Asthma
Education and Prevention Program, ―The ultimate goal of both expert care and patient selfmanagement
is to reduce the impact of asthma on related morbidity, functional ability and
quality of life.‖ Essential components of asthma management include treatment appropriate to
the severity of the asthma and the level of control achieved. Asthma control can be achieved by
avoidance of triggers, patient adherence to controller medication, and the patient‘s ability to
recognize asthma symptoms and respond appropriately. Other than the prescribing of
medications, all components require patient involvement to monitor, recognize, and respond to
asthma symptoms. The purpose of asthma education is, therefore, to help the patient to develop
the knowledge and skills to know when asthma is worsening, to take appropriate action, and to
be motivated to avoid triggers and adhere to the management regimen.
The aim of the present work was to enable asthmatic adults to proactively self-manage
bronchial asthma and sustain asthma quiescent status through utilization of the asthma action
plan.This study was a prospective, randomized trial comparing two asthmatic groups over a 6-
mo period to assess the effect of education and self-management plans.
The present RCT comprised 320 chronic asthmatic patients randomly assigned as 160
intervention group (n=160) and control group (n=160) attending the Chest Disease Department
of Gamal Abdel-Nasser Health Insurance Hospital in Alexandria. Data was collected through an
interviewing questionnaire. The study passed into three phases stations. During the preparatory
phase the health care provided managed to explain, fill and simplify the use of Arabic version of
AAP, to explain the proper utilization of the weekly follow-up form and to emphasize on the
weekly communication/ visit with the HCP to update their weekly follow-up records.
The main results of the present study were as follows:
1- The study patients of the intervention and control groups did not vary significantly in
their socio-demographic characteristics including age, gender, education, residence,
occupation, and socio-economic level.(P >0.05)
2- High BMI was a common finding. 69.4% and 29.7% of the studied patients were obese
and overweight.
3- The most frequent asthma triggers reported by asthmatics were seasonal variation
(80.3%), dust (76.2%), strong odors/perfumes (60.0%), flu (53.8%), emotion/stress
(45.0%), smoke (25.0%), GER (20.3%), and mold/moisture (19.7%)
4- Baseline asthma moderate control was found among the majority (82.5%) with no
significant difference between the studied participants.
5- During the follow up phase, the mean peak expiratory flow and the number of green zone
days was consistently higher throughout the 6-months period of the study among the
intervention group comparatively to the control one.
SUMMARY & CONCLUSION
87
6- The intervention group tended to self-mange their early asthma flares at home more than
the control group although the difference did not reach statistical significance.
7- Increment in the mean of the weeks of green (free of asthma symptoms and/ or personal
best PEF 80-100%) and yellow(mild-moderate asthma symptoms and/ or personal best
PEF 50-<80%) in the AAIG in comparison to the AACG was consistent at the
first(AAIG: 279±60.4 & 278±60.9 vs AACG: 256.9±69.5 & 255.3±72.1)and second
(AAIG: 221.0±51.3& 227.3±52.5 vs AACG: 195.5±53.1& 195.6± 57.6 ) stations (t=5.3,
7.7, 3.7 & 5.8, P <0.05).
8- Persistent superiority of the average of the green zone days in the AAIG over the AACG
month wise as well as at the first (85.0±4.9 AAIG vs 78.0±6.2 AACG) and
second[168.4±9.1 AAIG vs 156.2±8.2 AACG (t=11.1, p < 0.05) ] stations of the study
was evident as well
9- A significant higher development of moderate and severe persistent asthma in the AACG
than the AAIC at the first [0.05±0.2 AAIG vs 0.3±0.5 AACG, Z= -4.5, (P <0.05) ] and
second[ 1.0±0.2 AAIG vs 0.7±0.6 AACG, Z= -9.0, (P <0.05) ] stations.
10- In comparison to the AACG, the AAIG experienced significant more times of early
asthma flare up self-management concomitant with prominent lower times of ED visits,
hospitalization, admission at the ICU, private health facility and days of sickness leaves
& absenteeism at the first [86.6±3.5, 0.6±0.9, 0.2±0.7, 1.5±2.4, 2.5±0.7 & 6.7±4.9 AAIG
vs 83.0±5.5, 0.2±0.6, 0.1±0.6 ,0.04±0.3, 0.6±1.1 & 2.6±3.0 AACG (t = 2.8, 2.1, 8.7, 6.6,
7.4 respectively)] and second [173.3 ± 3.6, 1.0±1.1, 0.5±1.1, 3.0±3.1, 3.6±1.2 & 11.0±6.9
AAIG vs 165.1±7.9, 0.2±0.6, 0.1±0.6, 0.07± 0.3, 0.07±0.3, 3.8±4.7 AACG, (t = 6.2, 1.7,
4.2, 8.2 & 9.0 respectively, P <0.05)] stations.
11- The vertical analyses revealed solid DROP in the times of ED visits, hospitalization,
admission at ICU, private sector visits besides the days of sickness leave and absenteeism
among the AAIG at the end of the present study from the 6-month period prior to the
study by 85.1% (t= 17.7, P<0.05), 92.6% (t=10.8 , P <0.05), 11.1%, (t=0.8, P >.05),
61.4% (t=14.2, P<0.05), 2.6% and 68.6% (t= 10.9, P<0.05). The AACG got more times
of hospitalization, admission at ICU & hospitalization and sickness leave days by 64.0%
(t= -7.0, P<0.05), 37.3% (t= -2.3, P <0.05), and 60.1% (t= -12.1,P<0.05) respectively.
12- Marked improvement of patient adherence to asthma medications. Preponderance of the
high and medium adherence levels in the AAIG in comparison to the AACG was seen
month wise (F=5.9(H) & 7.0(M), P <0.05), at the first (Z= 1.9(H) &11.8(M), P <0.05)
and second (Z= 4.1(H) &12(M), P <0.05) stations. Whilst, low adherence level prevailed
significantly among the AACG comparatively to the AAIG was visible throughout the
study [F=0.14 month wise, Z= 12 at first station & F=12.1 at second station, P <0.05].
13- Adherence to AAP instructions and avoidance of asthma triggers were profoundly higher
in the AAIG than the AACG month wise (F=65535, P<0.05) as well as at the first
[87.2±3.1 AAIG vs 00.00 AACG (t=5.2, P <0.05)] and second [173.8±3.5 AAIG vs
00.00 AACG (t=5.2, P <0.05)] stations.
14- Adherence to medications and satisfaction with daily physical activity between the AAIG
and AACG didn‘t differ significantly month wise (P>0.05), they were significantly
higher in the AAIG than the AACG at the first [86.9±3.2 AAIG vs 84.6±4.5 AACG (t=
5.2, p<0.0001)] & [173.3±3.6 AAIG vs 168.2±6.3 AACG (t= 8.8, P<0.05)], and second
[84.2±5.7 AAIG vs 77.2±7.5 AACG (Z= 9.3, P<0.05)] & [167.0±11.4 AAIG vs
153.0±14.2 AACG (Z= 9.1, p<0.05)] follow up stations.
SUMMARY & CONCLUSION
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15- Forgetfulness to take medications according to the prescribed schedule and fear of having
the side effects of medications ad-hoc corticosteroids led them not to use or decrease its
dose/ frequency were the main reasons of non adherence as reported by the studied
patients.
16- A significant decrease in the ED visit, hospitalization and private sector visit costs by
96.60%, 90.60%, and 78.50% respectively from the corresponding baseline data. The
AACG experienced a significant increase in their hospitalization and admission at the
ICU costs by 160% and 37% respectively from the baseline respectively. In spite of the
increment of the costs of admission at the ICU (1.30%) among the AAIG and decrement
of the costs of the ED (74.90%) and private sector (52.10%) visits in the AACG, the total
asthma management costs significantly dropped in the AAIG by 18.7% and increased in
the AACG by 5%..
17- The days of patient-HCPs communication were significantly higher among the AACG
than the AAIG at the first [17.0+2.9 AACG vs 15.0+0.7 AAIG (Z= -9.5, P<0.05)] and
second [31.0+4.5 AACG vs 28.0+0.9 AAIG (Z= -9.5, P<0.05)] follow up stations.
18- Completeness of the patient-HCP communication was 100% in both groups throughout
the study. Unlike completeness, timeliness was slightly higher in the AAIG than the
AACG throughout the study; but the differences in-between were insignificant
CONCLUSION
These findings endorsed the hypothesis of the current randomized control trial that AAP is
a simple tool specifically designed to enhance patient knowledge, skills, capacity, confidence
and real time flare up self-management to achieve and sustain better asthma control. It
sufficiently enabled the asthmatic patients:
understand the problem and be a key person in the decision making of its management in
partnership with the HCPs
better understand, identify, focus on and avoid the asthma triggering factors
set up feasible patient-HCPs communication plan for exchanging instructions and data
strictly adhere to the HCP instruction and prescribed medications dosage and schedule
be vigilant enough to early symptoms of asthma flare up for real time self-management
get better asthma control and satisfied with their daily physical activities with consequent
DROP of EDs visits, hospitalization, admission at the ICUs and private sector visits
save the costs of the additional medicines and medical consultations
RECOMMENDATIONS
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RECOMMENDATIONS
1. For health care providers in chest clinics: training on the concept, components, stages of
the asthma action plan and asthma self-management approach
2. For the patient and families/caretakers: emphasize the concept of self management,
avoidance of asthma triggers, smoking cessation and life style modifications for
management of obesity.
3. Adoption of the AAP and self-management approach to all asthmatic patients through the
primary health care and family medicine centers
4. Preparation of guidelines for AAP and asthma self-management approach
5. Provision of peak flow meters to asthmatic patients to help them for self monitoring and
asthma self-managemnt.
6. Health education on the AAP and asthma self-management approach
7. Further large scale and hospital-based studies to assess specifically the cost-effectiveness
of the AAP and asthma self-management approach
8. Further national, large-scale population-based on the studies that assess the utilization of
the AAP in the self management of bronchial asthma