Thomas L. Creer

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.

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.

Psychological problems associated with drug therapy in childhood asthma

Ten studies designed to evaluate the psychological and behavioral effects of the antiasthma agent theophylline in children have been carried out to date. In this review, we evaluate the strengths and weaknesses of those investigations and discuss whether theophylline is responsible for learning disabilities or behavioral disorders such as hyperactivity. We also discuss the similarities between studies of theophylline and those of other xanthines, such as caffeine, to suggest that some persons appear to have a heightened response to these substances and would benefit from closer monitoring, not only of serum drug levels but also of their consumption of food and beverages that contain caffeine. In addition, we describe strategies for examining whether a functional relationship exists between theophylline use and behavioral and psychological changes in children.

Respiratory airway changes in response to suggestion in normal individuals.

&NA; Thirty normal individuals were told they were inhaling a substance that would either cause breathing difficulty (N = 15) or not affect breathing (N = 15). Total respiratory resistance was measured prior to and during inhalation. In reality, the subjects inhaled no substance; inhalation consisted of breathing normally into a respiratory resistance recorder. Individuals who received the former suggestion exhibited increased total respiratory resistance during inhalation, whereas individuals who received the latter suggestion did not. These observations demonstrated that the ability of suggestion to affect the respiratory airway is not limited to asthmatic individuals.

A single application of an aversive stimulus to eliminate chronic cough

Abstract There is increasing evidence that punishment can modify certain types of respiratory malfunctioning. In the present case, a single application of a mild electric shock totally suppressed the chronic coughing exhibited by a 14-yr-old boy. Follow-up after 2 1 2 yr indicates no further appearance of this behavior.

Improving perception of air flow obstruction in asthma patients.

Objective The objective of the study was to train asthma patients to improve their ability to discriminate added resistive loads. Methods Training consisted of a task in which patients judged the relative difficulty of breathing through two circuits. Difficulty of breathing through the circuits was varied by addition of resistive loads. We assigned 45 patients randomly to one of three conditions: a feedback plus fading condition, a feedback condition, and a control condition. Results Feedback of accuracy of judgments coupled with fading resulted in reduction of difference threshold. Neither feedback alone nor a control condition in which patients were given experience in making judgments without feedback resulted in threshold change. Conclusions Perception training with added resistive loads may help patients to detect an increase in air flow obstruction due to asthma before it becomes severe.

The complexity of treating asthma.

The World Health Report of 1997 (1), issued by the World Health Organization (WHO), focused on chronic diseases. The report noted that chronic diseases are responsible for more than 24 million deaths a year, or about half the rate of mortality in the world. A major contributor to the mortality rate is chronic respiratory disorders, particularly chronic obstructive pulmonary disease. Had the WHO Report summarized economic data on chronic disorders, they might have reported that total costs for people with chronic conditions in the United States alone amounted to

The effects of suggestion on the total respiratory resistance of nonasthmatic female subjects.

659 billion–

Improving recognition of respiratory sensations in healthy adults

425 billion in direct healthcare costs and

Unpredictable problems in applying social learning principles in a child care facility

234 billion in indirect costs-in 1990 (2). In short, chronic illness accounts for more than 60% of the