Investigation Of The South China Asthmatic’ Perceived Control Of Asthma And Exploration Of The Effective Interventions

BACKGROUND AND AIM:Asthma is one of the most common chronic airway inflammatory diseases. GINA(Global initiative for asthma) recommends the complete control of asthma as the main aims since 2006. The inadequately controlled asthma rate is still higher despite the emergence of new effective controller therapies. A global survey was conducted in 2004 among 29 countries’asthmatic patients and observed only 5% of asthmatic patients well controlled, but most of them are inadequately controlled. So it is urgently need to look for the risk factors that affect asthma control and explore the effective interventions to improve the asthma control in clinical work.Psychosocial factors play a significant role in impacting the asthma outbreak, influencing the patients’ management of asthma and forecasting the asthma outcome. Perceived control of asthma is a psychological factor, which is defined as individuals’ perceptions of their ability to deal with asthma and its exacerbations. It focuses on three aspects:self-efficacy, locus of control, and learned helplessness, including the patients’ perceived ability and confidence to cope with a given asthma situation and the degree their believe that their health is controlled by internal own actions or external factors or is determined by fate and the motivation, cognitive, and emotional changes resulted from previous exposure to negative outcomes, despite efforts to change the outcome. Katz used PCA in asthma study in 2002. Many foreign studies showed that the level of perceived control of asthma was related to the level of asthma control, the asthma severity, the asthma-specific quality of life and the emergency visits. Greater perceived control of asthma was associated with better asthma control and asthma-specific quality of life and less emergency visits. Some studies suggest that the level of patients’ perceived control of asthma inadequate, the lack of perceived control of asthma is the main barriers to self-management with the poorly controlled adult asthmatics. Therefore, the level of asthma control is likely to be an important psychosocial factors to the asthma outcome.But many foreign study found no matter adequately or inadequately controlled asthmatics, the level of PCA is low, Der Meer found PCA was low with poor asthma control (65%) and with good asthma control (17%), the low of PCA is the most barrior to self-management. Therefore, it is important to enhance the patients’ PCA.In China, there are also many studies paying attention to the relationship between psychological factors and asthma, including depression, anxiety, et al, but few research concerns the perceived control of asthma, so there’s little data about the level of Chinese asthmatics’level of perceived control of asthma and there is on study pay attition to the risk factors of PCA at home and abroad. So one of the purposes of this study is to investigate the level of the South China asthmatic’PCA and explore the risk factors, as to provide a theoretical basis for the asthma management.Many studys found PCA is important to asthma outcomes, so it is nesserary to enhance the level of PCA, but Calfee CS found the current self-management strategies can’t improve PCA. The current self-management strategies, including self-PEF-monitoring, recording asthma diary, taking part in asthma education sessions, have been proved effective in many previous clinical trials. Mobile SMS have been applied to asthma self-management in foreign countries since 1990s, Studies showed Internet and Mobile Short message service (SMS) are potentially powerful tools helping to overcome these external barriers, but there is no study about can it also solve the internal barrier, for PCA. China has a large number of patients with asthma, and also has a rich network communication resources, but in China, except Taiwan, Mobile SMS have not yet been applied. So the another purpose of this study is to prove the possibility of establish Mobile SMS asthma self-management in our country, then compare the advantages of Mobile SMS with the current self-management strategies in improving the level of perceived control of asthma and the level of asthma control and asthma-related quality of life, so as to establish one more simple and effective asthma self-management mode.SUBJECTS AND METHODS:PartⅠ:Investigation of the level of South China asthmatic’perceived control of asthma and the risk factors.A total of 150 asthmatic out-patients who see a doctor between Mar-2009 and Apr-2010 were recruited,19～65 (38.6±11.7)years old,86 males and 64 females asthma duration 3 months to 40 years, consisting intermittent and mild persistent patients46(30.7%), moderate 49 (32.7%), severe55 (36.6%) according to the lung function FEV1%.They were asked to complete the demographic characteristics perceived control of asthma (PCAQ-6) scales, asthma control test (ACT) scales and Standard asthma-specific quality of life (AQLQ (S)) scale. Lung function test, blood cell count and induced sputum cell count were also performed, then investigation of the level of South China asthmatic’ perceived control of asthma,the relationship between PCA and the level of asthma control, and explore the risk factors to PCA.PartⅡ:Exploration the effective interventions to improve the PCA and the asthma outcome.All the patients attended in PartⅠwere randomly divided into three groups: general out-patient education, PEF+ asthma education book, Mobile SMS. The second visits were followed by 12 weeks±7 days, at the end of the study, all participants were asked to report PCAQ-6, ACT, AQLQ (S) again, Then Comparison the different influence of the three asthma education styles to PCA, medication adherence and asthma outcomes (asthma control, asthma asthma-specific quality of life, lung function FEV1%, blood and sputum inflammation indicators), to prove the possibility of establish Mobile SMS asthma self-management in our country, so as to establish one more simple and effective asthma self-management mode to use.STATISTICAL ANALYSIS:The results were analyzed by SPSS13.0. Normality test of measurement data were carried out. If the data accord with normal distribution, they would be presented as means±SD, data of skewed distribution are presented as median (min, max); and t test and chi-squared analyses were conducted for comparison the level of PCA with the newly large clinical published results. Bivariate analysis between the PCA and demographic variables and other clinical data was performed. Multiple linear regression was constructed to evaluate the relationship between PCA and the related factors. Within-group changes used paired-samples T test. We used chi-squared analyses to compare the follow-up adherence rate and One-Way ANOVA to compare the between-group clinical data changes and LSD or Tambanes’s T2 methods were used to compare differences between three groups. We controlled the covariates found in visit-one data when we analyzed the second visit variable data. Significance was accepted when P<0.05.RESULTS:PartⅠ:1.150 eligible asthmatic out-patients were recruited into survey and completed the scales and examination, PCAQ-6 scores were between 10-26 (18.75±3.42),male 18.60±3.28,female18.95±3.61, lower than abroad (P<0.001).2. PCA correlated significantly and positively with the level of asthma control(r=0.377,P<0.001) and AQLQ (S) (r=0.675, P<0.001) as well as all four domains of AQLQ (S) (activity limitations, emotional function, exposure to environmental stimuli and symptoms).3. The risk factors of inadequate PCA were asthma duration, the lung function and the percentage of blood neutrophils.PartⅡ:1. At the end of the mobile SMS and PEF+ asthma education book asthmatics education program, the PCAQ-6 score and the AQLQ(S) score were improved significantly about than before(P<0.001), these two styles were no significant difference to improve PCAQ-6, But significant difference to improve AQLQ(S) score2. The Change in PCAQ-6 score was related to change in AQLQ(S) score (P=0.001).3.There were 14 patients came back at the second visit who received common out-patient asthma education, while 27 patients PEF+ asthma education book and 30 patients mobile SMS. The follow-up adherence rate was 28%、54%、60% respectively. There is significantly difference between three groups(χ2=11.606, P=0.003), More asthma patients received mobile SMS came back than PEF+ asthma education book and common out-patient asthma education.4. There was no significantly change in medication adherence, emergency visits, and ACT score changes, lung function FEV1% changes, blood and sputum inflammation indicators changes in three groups. CONCLUSIONS:1. The level of the PC A about Southern Chinese asthmatics was inadequate.2. The risk factors of inadequate PCA were asthma duration, the lung function FEV1% and the percentage of blood neutrophils.3. Mobile SMS is not less than The function of PEF+ asthma education book on enhancing PCA, follow-up adherence rate, asthma-specific quality of life, and SMS is more useful to enhance follow-up adherence rate and asthma-specific quality of life than Mobile SMS.4. The PCA could affect the level of asthma control and the asthma-specific quality of life. he increase of perceived control of asthma can bring in the improvement of the asthma related life quality.5. Mobile SMS is an new and useful asthma education self-management strategies.