Skip to main content
PMC home page
Thorax logoLink to Thorax
. 2005 Jul 29;60(12):1003–1011. doi: 10.1136/thx.2005.043877

The Coping with Asthma Study: a randomised controlled trial of a home based, nurse led psychoeducational intervention for adults at risk of adverse asthma outcomes

J Smith 1, S Mildenhall 1, M Noble 1, L Shepstone 1, M Koutantji 1, M Mugford 1, B Harrison 1
PMCID: PMC1747261  PMID: 16055616

Abstract

Background: Morbidity and mortality associated with severe asthma might be reduced by interventions that address psychosocial factors contributing to adverse outcomes. A study was undertaken to assess the effectiveness of a 6 month home based psychoeducational intervention delivered by a respiratory nurse specialist for adults at risk of adverse asthma outcomes.

Methods: A pragmatic randomised controlled trial was performed in 92 adults registered with hospital or primary care asthma clinics. All had previous hospital admissions and/or were on British Thoracic Society step 4–5 treatment and had failed to attend clinic appointments or were considered to have poor adherence to other aspects of their agreed management. Patients were visited in their homes for assessment and, where appropriate, intervention. The main outcomes measured were symptom control, asthma specific quality of life, and generic health status.

Results: At the 6 month primary time point there were no significant differences between usual care and intervention groups in mean symptom control, physical functioning, or mental health scores (differences (with 95% CI) –0.35 (–1.83 to 1.13), 3.10 (–11.42 to 17.63), 0.42 (–10.22 to 11.07), respectively). Small effects on asthma specific quality of life up to 12 months (e.g. adjusted difference at 12 months 0.13 (95% CI 0.02 to 0.25)) and short term effects on generic health status, which mirrored improvements in aspects of self-care observed at the end of the intensive phase of the intervention, were apparent only from fully adjusted analyses.

Conclusions: A home based intervention provided by a nurse receiving psychological supervision may have effects on quality of life but is overall of limited long term benefit to adults at risk of adverse asthma outcomes.

Full Text

The Full Text of this article is available as a PDF (109.9 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bland J. M., Altman D. G. Some examples of regression towards the mean. BMJ. 1994 Sep 24;309(6957):780–780. doi: 10.1136/bmj.309.6957.780. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Campbell D. A., McLennan G., Coates J. R., Frith P. A., Gluyas P. A., Latimer K. M., Luke C. G., Martin A. J., Roder D. M., Ruffin R. E. A comparison of asthma deaths and near-fatal asthma attacks in South Australia. Eur Respir J. 1994 Mar;7(3):490–497. doi: 10.1183/09031936.94.07030490. [DOI] [PubMed] [Google Scholar]
  3. Campbell D. A., Yellowlees P. M., McLennan G., Coates J. R., Frith P. A., Gluyas P. A., Latimer K. M., Luke C. G., Martin A. J., Ruffin R. E. Psychiatric and medical features of near fatal asthma. Thorax. 1995 Mar;50(3):254–259. doi: 10.1136/thx.50.3.254. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Crane J., Pearce N., Burgess C., Woodman K., Robson B., Beasley R. Markers of risk of asthma death or readmission in the 12 months following a hospital admission for asthma. Int J Epidemiol. 1992 Aug;21(4):737–744. doi: 10.1093/ije/21.4.737. [DOI] [PubMed] [Google Scholar]
  5. FitzGerald J. M., Turner M. O. Delivering asthma education to special high risk groups. Patient Educ Couns. 1997 Dec;32(1 Suppl):S77–S86. doi: 10.1016/s0738-3991(97)00099-2. [DOI] [PubMed] [Google Scholar]
  6. Harrison B. D. Psychosocial aspects of asthma in adults. Thorax. 1998 Jun;53(6):519–525. doi: 10.1136/thx.53.6.519. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Hays R. D., Morales L. S. The RAND-36 measure of health-related quality of life. Ann Med. 2001 Jul;33(5):350–357. doi: 10.3109/07853890109002089. [DOI] [PubMed] [Google Scholar]
  8. Hyland M. E., Finnis S., Irvine S. H. A scale for assessing quality of life in adult asthma sufferers. J Psychosom Res. 1991;35(1):99–110. doi: 10.1016/0022-3999(91)90011-c. [DOI] [PubMed] [Google Scholar]
  9. Innes N. J., Reid A., Halstead J., Watkin S. W., Harrison B. D. Psychosocial risk factors in near-fatal asthma and in asthma deaths. J R Coll Physicians Lond. 1998 Sep-Oct;32(5):430–434. [PMC free article] [PubMed] [Google Scholar]
  10. Javadpour S. M., Selvadurai H., Wilkes D. L., Schneiderman-Walker J., Coates A. L. Does carbon dioxide retention during exercise predict a more rapid decline in FEV1 in cystic fibrosis? Arch Dis Child. 2005 Aug;90(8):792–795. doi: 10.1136/adc.2004.070110. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Katz Patricia P., Yelin Edward H., Eisner Mark D., Blanc Paul D. Perceived control of asthma and quality of life among adults with asthma. Ann Allergy Asthma Immunol. 2002 Sep;89(3):251–258. doi: 10.1016/S1081-1206(10)61951-5. [DOI] [PubMed] [Google Scholar]
  12. Kolbe J., Fergusson W., Vamos M., Garrett J. Case-control study of severe life threatening asthma (SLTA) in adults: demographics, health care, and management of the acute attack. Thorax. 2000 Dec;55(12):1007–1015. doi: 10.1136/thorax.55.12.1007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Kolbe J., Vamos M., Fergusson W., Elkind G. Determinants of management errors in acute severe asthma. Thorax. 1998 Jan;53(1):14–20. doi: 10.1136/thx.53.1.14. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Mohan G., Harrison B. D., Badminton R. M., Mildenhall S., Wareham N. J. A confidential enquiry into deaths caused by asthma in an English health region: implications for general practice. Br J Gen Pract. 1996 Sep;46(410):529–532. [PMC free article] [PubMed] [Google Scholar]
  15. Morisky D. E., Green L. W., Levine D. M. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986 Jan;24(1):67–74. doi: 10.1097/00005650-198601000-00007. [DOI] [PubMed] [Google Scholar]
  16. Oga Toru, Nishimura Koichi, Tsukino Mitsuhiro, Sato Susumu, Hajiro Takashi, Mishima Michiaki. Comparison of the responsiveness of different disease-specific health status measures in patients with asthma. Chest. 2002 Oct;122(4):1228–1233. doi: 10.1378/chest.122.4.1228. [DOI] [PubMed] [Google Scholar]
  17. Richards G. N., Kolbe J., Fenwick J., Rea H. H. Demographic characteristics of patients with severe life threatening asthma: comparison with asthma deaths. Thorax. 1993 Nov;48(11):1105–1109. doi: 10.1136/thx.48.11.1105. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Smith Jane R., Mildenhall Sue, Noble Michael, Mugford Miranda, Shepstone Lee, Harrison Brian D. W. Clinician-assessed poor compliance identifies adults with severe asthma who are at risk of adverse outcomes. J Asthma. 2005 Jul-Aug;42(6):437–445. doi: 10.1081/JAS-67949. [DOI] [PubMed] [Google Scholar]
  19. Sturdy P. M., Victor C. R., Anderson H. R., Bland J. M., Butland B. K., Harrison B. D. W., Peckitt C., Taylor J. C., Mortality and Severe Morbidity Working Group of the National Asthma Task Force Psychological, social and health behaviour risk factors for deaths certified as asthma: a national case-control study. Thorax. 2002 Dec;57(12):1034–1039. doi: 10.1136/thorax.57.12.1034. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Ware J. E., Jr, Sherbourne C. D. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992 Jun;30(6):473–483. [PubMed] [Google Scholar]
  21. Wareham N. J., Harrison B. D., Jenkins P. F., Nicholls J., Stableforth D. E. A district confidential enquiry into deaths due to asthma. Thorax. 1993 Nov;48(11):1117–1120. doi: 10.1136/thx.48.11.1117. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Wright R. J., Rodriguez M., Cohen S. Review of psychosocial stress and asthma: an integrated biopsychosocial approach. Thorax. 1998 Dec;53(12):1066–1074. doi: 10.1136/thx.53.12.1066. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Yoon R., McKenzie D. K., Miles D. A., Bauman A. Characteristics of attenders and non-attenders at an asthma education programme. Thorax. 1991 Dec;46(12):886–890. doi: 10.1136/thx.46.12.886. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Zigmond A. S., Snaith R. P. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983 Jun;67(6):361–370. doi: 10.1111/j.1600-0447.1983.tb09716.x. [DOI] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES