Positive change in asthma control using therapeutic patient education in severe uncontrolled asthma: a one-year prospective study

Xiaoxian Zhang, Zhengdao Lai, Rihuang Qiu, E Guo, Jing Li, Qingling Zhang, Naijian Li, Xiaoxian Zhang, Zhengdao Lai, Rihuang Qiu, E Guo, Jing Li, Qingling Zhang, Naijian Li

Abstract

Background: Severe asthma is difficult to control. Therapeutic patient education enables patients to better understand their disease and cope with treatment, but the effect of therapeutic patient education in severe uncontrolled asthma is unclear. We evaluated whether therapeutic patient education is effective in improving asthma control and decreasing the frequency of exacerbations in severe uncontrolled asthma.

Methods: This was a prospective, observational, and self-controlled study that enrolled 40 subjects with severe uncontrolled asthma. Patients were seen at a clinic four times (on day 1 and after 3, 6, and 12 months). After baseline data collection, the subjects completed a therapeutic patient education program and were also followed-up via telephone after 1, 2, 4, 5, 7, 8, 9, 10, and 11 months to monitor asthma medication adherence and collect asthma-related information.

Results: Within the 1-year study period, a total of 23 exacerbations were recorded in 14 patients, seven of whom required emergency treatment and two of whom were hospitalized. Twelve months after the standardized therapeutic patient education program, pulmonary function and fractional exhaled nitric oxide levels improved significantly in all 40 patients. Moreover, the scores from three standardized asthma questionnaires and indices suggested improved quality of life in these patients with severe uncontrolled asthma. Serum levels of biomarkers reflecting asthma immune responses did not change between baseline and the 1-year follow-up time point.

Conclusions: Therapeutic patient education is effective in improving asthma control and decreasing exacerbations in patients with severe uncontrolled asthma.

Keywords: Asthma control; Severe uncontrolled asthma; Therapeutic patient education.

Conflict of interest statement

There are no conflicts of interest to declare. There is also no non-author involvement in the preparation of the manuscript.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Changes in participant total exacerbations, spirometry, and fractional exhaled nitric oxide (FeNO) over the course of the study. A Asthma exacerbations decreased significantly after therapeutic patient education (TPE). B–D Measurements were conducted on day 1 (visit 1) and after 6 months (visit 3) and 12 months (visit 4). Predicted forced expiratory volume in 1 s (FEV1) increased significantly and FeNO decreased over time. Medication adherence was calculated as the percentage of prescribed doses taken each week. *p < 0.05, **p < 0.01, ***p < 0.001
Fig. 2
Fig. 2
Asthma symptoms, level of asthma control, and asthma-related quality of life. A Asthma Control Questionnaire 5 scores decreased significantly from visit 1 (day 1) to visit 3 (6 months after baseline) and visit 4 (12 months after baseline). Asthma Symptom Utility Index scores (B) and Standardized Asthma Quality of Life Questionnaire scores (C) increased over time. D Standardized Asthma Quality of Life Questionnaire scores in four domains increased over time, especially the activity domain score after 6 and 12 months and the emotional domain score after 6 months. *p < 0.05, **p < 0.01, ***p < 0.001
Fig. 3
Fig. 3
Changes in serum levels of asthma-related biomarkers. There were no significant changes over time between serum levels of interleukins (IL), tumor necrosis factor α (TNF-α), eotaxin, or transforming growth factor β1 (TGF-β1). Visit 1, day 1; visit 3, 6 months after baseline; visit 4, 12 months after baseline

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Source: PubMed

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