Asthma is a chronic respiratory condition that affects millions of people worldwide. It is a major public health concern, with more than 330 million individuals currently diagnosed with the disease. In the United Kingdom, approximately six million people live with asthma, while in the United States, the number exceeds 25 million. This widespread prevalence highlights the significant burden asthma places on individuals, healthcare systems, and society as a whole.

Despite advances in medical treatment and awareness, asthma continues to be a leading cause of morbidity and mortality. The condition is responsible for around 250,000 deaths each year, many of which are preventable with proper management. Experts predict that by 2025, the number of people living with asthma will surpass 400 million, reflecting the growing impact of the disease. This rise in cases can be attributed to multiple factors, including increased urbanisation, environmental pollution, climate change, and genetic predisposition.

Although the introduction of inhaled glucocorticoids has significantly reduced asthma-related deaths, the overall global burden remains substantial. Many patients still experience uncontrolled symptoms, frequent exacerbations, and a diminished quality of life. As a result, researchers and healthcare professionals continue to explore effective strategies to improve asthma management and minimise its impact on daily life.

Challenges in Asthma Management

Managing asthma effectively requires more than just prescribing medication. Many patients struggle to control their symptoms due to a lack of awareness, inconsistent treatment adherence, and inadequate healthcare support. Simply providing information about asthma has proven insufficient in improving patient outcomes, as knowledge alone does not always translate into effective self-care practices.

International guidelines, such as those issued by the Global Initiative for Asthma (GINA) and the British Thoracic Society/Scottish Intercollegiate Guidelines Network (BTS/SIGN), stresses the importance of self-management interventions. These interventions focus on encouraging patients to take an active role in their care by equipping them with the necessary skills and tools to manage their condition independently.

Self-management programs typically include three key components: education, self-monitoring, and regular medical review. Education involves teaching patients about asthma triggers, medication use, and symptom recognition. Self-monitoring encourages individuals to track their symptoms, peak flow measurements, and medication usage. Regular medical reviews ensure that treatment plans remain effective and are adjusted as needed based on the patient’s progress.

Different Approaches to Self-Management

There are several models of self-management, each varying in the level of professional support provided. These approaches cater to different patient needs, ranging from minimal intervention to comprehensive multidisciplinary care.

Minimally Supported Self-Management

This model provides patients with basic guidance on managing their asthma but lacks ongoing professional support. Individuals receive educational materials and general advice but do not have scheduled follow-ups with healthcare providers. While this approach can be beneficial for highly motivated patients who already have good disease control, it is generally less effective in reducing emergency hospital visits and improving long-term outcomes.

Patients who follow this approach may struggle to recognise when their symptoms are worsening, leading to delayed medical intervention. Additionally, without professional reinforcement, adherence to treatment plans may decline over time, resulting in poorly controlled asthma. Although minimally supported self-management can be a cost-effective option, it is not suitable for all patients, particularly those with moderate to severe asthma.

Regularly Supported Self-Management

A more structured approach, regularly supported self-management includes scheduled follow-ups with healthcare professionals. This model typically involves at least two hours of professional support, ensuring that patients receive consistent guidance and monitoring.

Research has shown that regularly supported self-management is the most effective intervention in reducing healthcare utilisation, such as emergency department visits and hospital admissions. Patients benefit from frequent interactions with healthcare providers, who can assess their condition, adjust treatment plans, and reinforce self-management education. This approach also improves adherence to medication, as patients feel more accountable for following their prescribed regimen.

Furthermore, written action plans play a crucial role in this model. These personalised plans outline specific steps patients should take based on their symptoms, including when to increase medication or seek medical attention. Having a clear and accessible action plan encourages individuals to respond proactively to symptom changes, reducing the risk of severe asthma attacks.

Multidisciplinary Case Management

For individuals with severe or poorly controlled asthma, multidisciplinary case management offers a comprehensive approach to care. This model involves collaboration among various healthcare professionals, including physicians, nurses, respiratory therapists, and pharmacists.

Multidisciplinary case management is particularly beneficial for patients with frequent hospitalisations, complex medication regimens, or multiple comorbidities. By coordinating care across different specialties, this approach ensures that all aspects of a patient’s health are addressed. However, research suggests that while multidisciplinary management is effective for severe cases, it is not as impactful as regularly supported self-management for the broader asthma population.

One of the challenges of this model is its resource-intensive nature. It requires significant investment in healthcare personnel, infrastructure, and coordination, which may not be feasible in all healthcare settings. Nonetheless, for high-risk patients, this approach provides essential support and improves long-term health outcomes.

Alternatives to Self-Management Interventions

With advancements in technology, new alternatives to traditional self-management interventions have emerged. One such approach involves self-monitoring models that utilise telehealth and smartphone applications. These digital tools allow patients to track their symptoms, medication use, and environmental triggers without direct professional review.

While these tools can enhance patient engagement and provide valuable insights into asthma patterns, research indicates that self-monitoring alone is not sufficient. Without professional support and intervention, digital self-monitoring does not significantly reduce hospital visits or improve overall asthma control. Therefore, while technology can complement traditional self-management approaches, it should not replace direct healthcare involvement.

Evidence from Research and Meta-Analysis

A growing body of research supports the effectiveness of structured self-management interventions. The PRISMS study, which analysed 27 systematic reviews, found that self-management programs significantly reduce hospital admissions and improve health-related quality of life.

Similarly, a network meta-analysis of 105 randomised controlled trials involving 27,767 participants confirmed the superiority of regularly supported self-management. The findings showed that this model led to the best outcomes in terms of reducing exacerbations, improving symptom control, and enhancing quality of life. In contrast, self-monitoring without professional involvement was largely ineffective, highlighting the importance of healthcare support.

Key Findings and Recommendations

Several key findings emerge from the research on asthma self-management. The most effective approach involves at least two hours of professional support, ensuring that patients receive the necessary guidance and reinforcement. Regular medical reviews are essential in maintaining treatment adherence and adjusting management plans as needed.

A team-based approach to asthma management is highly beneficial. Physicians, nurses, educators, and community health workers all play a role in supporting patients. Collaboration among these professionals ensures that individuals receive comprehensive care personalised to their specific needs.

Asthma action plans should be actively used and easily accessible. Whether in digital or written form, these plans serve as essential tools for patients, helping them recognise symptoms and take appropriate action promptly. Integrating action plans into electronic health records allows healthcare providers to monitor patient progress and make timely adjustments to treatment plans.

Despite the proven benefits of self-management, barriers to implementation persist. Time constraints, organisational challenges, and a lack of training for healthcare professionals can hinder the adoption of effective strategies. Addressing these barriers requires systemic changes, such as improving healthcare training programs, increasing resource allocation, and promoting policy initiatives that support self-management adoption.

Mobile health interventions offer promising solutions to enhance self-management practices. By incorporating culturally appropriate strategies, digital tools can improve patient engagement and facilitate better asthma control. However, these interventions should be integrated with traditional healthcare support to maximise their effectiveness.

Conclusion

Asthma remains a significant global health challenge, affecting millions of individuals and placing a considerable burden on healthcare systems. While medical advancements have improved treatment outcomes, effective self-management remains the foundation of asthma care.

Regularly supported self-management has proven to be the most effective intervention, reducing hospital admissions, improving symptom control, and enhancing overall quality of life. However, successful implementation requires a team-based approach, regular professional support, and active use of asthma action plans.

By addressing barriers to self-management and leveraging technological advancements, healthcare systems can encourage patients to take control of their condition. With continued investment in education, training, and policy support, asthma self-management can lead to improved health outcomes and a better quality of life for millions worldwide.

Reference

Hodkinson, A., Bower, P., Grigoroglou, C., Zghebi, S. S., Pinnock, H., Kontopantelis, E., & Panagioti, M. (2020). Self-management interventions to reduce healthcare use and improve quality of life among patients with asthma: systematic review and network meta-analysis. BMJ (Clinical Research Ed.), 370, m2521. https://doi.org/10.1136/bmj.m2521

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Masoli, M., Fabian, D., Holt, S., & Beasley, R. (2004). Global Initiative for Asthma (GINA) Program. The global burden of asthma: executive summary of the GINA Dissemination Committee report. Allergy, 59, 469–478. https://doi.org/10.1111/j.1398-9995.2004.00526.x

Global Initiative for Asthma. 2019 GINA Report, Global Strategy for Asthma Management and Prevention. 2019. https://ginasthma.org/ wp-content/uploads/2019/06/GINA-2019-main-report-June-2019wms.pdf.