Münks-Lederer C, Dhein Y, Richter B, Worth H
Medizinische Klinik I, Klinikum Fürth, Fürth.
Pneumologie. 2001 Feb;55(2):84-90. doi: 10.1055/s-2001-11285.
The efficacy of a structured education programme (AFAS) unter outpatient conditions was evaluated in a pilot study including 25 mild to severely ill adult asthmatics (age 41 +/- 2 yrs.) over a period of two and a half years. The main teaching items of the programme are: self-control of the disease with regular peak flow measurements, monitoring of symptoms with a patient diary, effects and side effects of the treatment, correct inhalation technique of asthma medication and the ability of self-management with regard to the actual degree of airflow limitation by the patients.
After AFAS the knowledge of the patients regarding the disease as well as the medication increased significantly. There was an improvement of drug therapy: before AFAS only 52% of the patients used inhaled steroids on a regular basis with regard to 96% one and two years after participation of AFAS (p < 0.01). The self-control of the disease was improved: before AFAS no patient measured peak flow during acute dyspnoea, compared with 88% (p < 0.001) and 75% (p < 0.001) one and two years after AFAS, respectively. The number of severe asthma-attacks decreased significantly from 10.7 +/- 2.5 per patient and year before education to 1.3 +/- 0.2 (p < 0.001) after the first year and to 2.0 +/- 0.3 (p < 0.05) after the second year. The total number of hospital days due to asthma decreased from 219 days in the year before the participation in AFAS to zero (p < 0.001) in the first year after the education and to 17 days (p < 0.001) after the second year.
The efficacy of patient education with AFAS is still evident two years after the course, but a reduction of self-control of the disease was observed during the follow-up period. In conclusion, structured education programmes for adult asthmatics can be effective even under outpatient conditions.
在一项试点研究中，对25名轻至重度成年哮喘患者（年龄41±2岁）进行了为期两年半的门诊结构化教育项目（AFAS）疗效评估。该项目的主要教学内容包括：通过定期测量呼气峰流速进行疾病自我管理，使用患者日记监测症状，了解治疗的效果和副作用，掌握哮喘药物的正确吸入技术以及患者根据实际气流受限程度进行自我管理的能力。
AFAS实施后，患者对疾病及药物的了解显著增加。药物治疗得到改善：AFAS实施前，仅有52%的患者定期使用吸入性类固醇，而参与AFAS一年和两年后这一比例分别为96%（p<0.01）。疾病自我管理能力得到提高：AFAS实施前，没有患者在急性呼吸困难时测量呼气峰流速，而AFAS实施一年和两年后，这一比例分别为88%（p<0.001）和75%（p<0.001）。严重哮喘发作次数从教育前每位患者每年10.7±2.5次显著减少至第一年的1.3±0.2次（p<0.001），第二年为2.0±0.3次（p<0.05）。因哮喘住院的总天数从参与AFAS前一年的219天降至教育后第一年的零天（p<0.001），第二年为17天（p<0.001）。
AFAS患者教育课程结束两年后疗效依然显著，但在随访期间观察到疾病自我管理能力有所下降。总之，即使在门诊条件下，针对成年哮喘患者的结构化教育项目也可能有效。
