Self-management, autonomy, and quality of life in asthma. Population Medicine Group 91C.

STUDY OBJECTIVE

Asthma management guidelines emphasize increased autonomy for asthmatics through patient education and patient-initiated action plans. The aim of this study was to examine autonomy, as reflected in the preferences of asthmatic subjects for decision making and their preferences for information seeking. The results were related to quality of life in asthma.

SUBJECTS

One hundred twenty-three adults with asthma.

DESIGN

Questionnaire-based cross-sectional analytic survey.

SETTING

Eighty-five subjects were recruited from community pharmacies at the point of sale of albuterol inhalers for asthma and compared with 38 subjects recently hospitalized for acute severe asthma.

MEASUREMENTS

Asthma-related quality of life, autonomy preferences questionnaire.

RESULTS

The subjects in both groups had a mild-to-moderate quality of life impairment in all domains that was greater in the posthospitalization group (p < 0.05). Both groups expressed strong preferences for information concerning their condition (92se 0.8, 91se 1.1, out of a possible 100). Subjects did not prefer to make decisions alone about the management of asthma exacerbations (51.0se 1.2, 52.5 se2.0, out of a possible 100). As the severity of the asthma exacerbation increased, the desire to make decisions decreased (p < 0.05). Older subjects expressed less desire for decision making than younger subjects. Self-management autonomy was not correlated with quality of life in asthma.

CONCLUSIONS

We conclude that while asthmatics have strong desires to be informed about their illness, they do not wish to be the prime decision makers during an exacerbation. These findings have implications for the success of self-management programs and action plans.