The Role of a Self-management Program in the Control of Mild to Moderate Asthma: a Randomized Controlled Study

Background: Asthma patient education has been recognized as an important component of asthma control. The aim of the present study was to carry out a cost-effectiveness analysis of patient education in patients with mild to moderate asthma during 6 months of follow up. Methods: We randomly allocated asthma patients who were covered by health insurance to a control group (group C) or a self-management group (group S). Self-management consisted of measurement of peak expiratory flow (PEF) and monthly individual education and advice by a specialist. Effectiveness was evaluated on the basis of PEF, quality of life, and mean total cost of medical expenses. Furthermore, we asked the patients about symptom improvement and their level of satisfaction with this program. Results: PEF values in group S gradually increased at 3 months after the self-management program and remained at high levels. The total costs decreased by 30% from baseline in group S, whereas they increased by 15% in group C. The cost of one-day visits showed no difference between the two groups, but the frequency of visits to general practitioners decreased in group S as compared with group C. Furthermore, the number of episodes of asthma attacks decreased in group S but not in group C, and 94% of the group S patients replied that they considered the self-management program to have been useful. Conclusions: We conclude that an individual self-management program is not only a safe and effective aid in the treatment of mild to moderate asthma but can also reduce medical expenses

Optimal step-down approach for pediatric asthma controlled by salmeterol/fluticasone: A randomized, controlled trial (OSCAR study)

Background: Several guidelines, including the Japanese Pediatric Guideline for the Treatment and Management of Asthma (JPGL), recommend salmeterol/fluticasone combination therapy (SFC) as step 3 to 4 treatment for moderate to severe asthma. However, the optimal step-down approach to SFC remains unclear. In the current study, we examined step-down approaches in asthmatic children whose symptoms had been stabilized by SFC 100/200 μg/day. Methods: This randomized, multicenter, open-label, parallel-group study was conducted over 12 weeks. For step-down therapy, subjects aged 5–15 years were randomly assigned to an SFC group (25/50 μg b.i.d.) or an FP group (100 μg b.i.d.), and treated for 12 weeks. Childhood Asthma Control Test (C-ACT) scores, lung function, and exhaled nitric oxide (FeNO) levels were monitored. Results: Of 131 enrolled subjects, 128 completed the study and were included in the analysis. Decreases in % peak expiratory flow rate and % forced expiratory flow at 50% of vital capacity (V50) were observed in the FP group at each time point. There was a significant difference between the two groups for the change in %V50 from its previous value at each time point. There were no significant changes in FeNO levels (range 15–20 ppb) or C-ACT scores (∼26 points) within or between groups. Conclusions: A high level of asthma control was maintained with both approaches. The use of SFC step-down resulted in somewhat better respiratory function, with no worsening of airway inflammation. However, halving the dose of SFC and switching to FP alone are both optimal step-down approaches