Efficacy of a structured audio-visual asthma care session during GP visit in Australia: a single GP centre intervention trial
Md Imrose Hasan A , K. M. Shahunja
B C * and Abdullah Mamun B C
A
B
C
Abstract
This study aims to assess the effectiveness of a structured audio-visual educational session for people on asthma symptoms management during a general practitioner visit.
We conducted this single-centre intervention study in a general practice clinic in Queensland, Australia. There were 78 intervention and 78 control participants in this study. We followed 1:1 randomisation to allocate study intervention between two groups of participants with asthma. The intervention group received an audio-visual demonstration of asthma, its symptoms, triggers, and how to use inhalers correctly, along with the standard asthma management by a physician on enrolment. The control group received only the standard asthma management by a physician. We assessed the ‘Asthma Control Test’ score on enrolment and after 90 days and compared the changes across the groups.
Participants were, on average, 28 years old (range: 6–60, 60% women). The intervention group showed a 1.9-unit increment, and the control group showed a −0.5-unit increment in ‘Asthma Control Test’ score from baseline to endline. The difference of differences between the intervention and control groups was 2.4 units (P = 0.016) after adjusting for potential confounders. In age-stratified analysis, the children (6–17 years) showed a significant difference (mean difference of 2.5 between intervention and control groups) in their asthma control score.
Structured educational sessions involving audio-visual media along with standard management for people with asthma during general practice visits would be effective for better asthma control. However, a further multi-centre study with a larger sample is needed to see its efficacy.
Keywords: asthma, asthma control, asthma education, audio-visual, Australia, efficacy, GP, intervention.
References
Ahluwalia SK, Matsui EC (2011) The indoor environment and its effects on childhood asthma. Clinical Immunology 11, 137-143.
| Google Scholar |
AIHW (2020) Asthma. Australian Institute of Health Welfare, Canberra. Available at https://www.aihw.gov.au/reports/chronic-respiratory-conditions/asthma
AIHW (2021) Older Australians. Australian Institute of Health and Welfare, Canberra. Available at https://www.aihw.gov.au/reports/older-people/older-australians/contents/summary
Apelberg BJ, Aoki Y, Jaakkola JJK (2001) Systematic review: exposure to pets and risk of asthma and asthma-like symptoms. Journal of Allergy and Clinical Immunology 107, 455-460.
| Crossref | Google Scholar | PubMed |
Asthma Australia (2021) Asthma control questionnaire. Available at https://asthma.org.au/wp-content/uploads/2021/09/The-Asthma-Control-Test-ACT-PDF-with-infographic_2021.pdf [Accessed 1 March 2024]
Bainbridge R, Mccalman J, Clifford A, Tsey K (for the Closing the Gap Clearinghouse) (2015) Cultural competency in the delivery of health services for Indigenous people. (AIHW: Canberra) Available at https://doi.org/10.25816/5ec4ba84d1241
Baptist AP, Hao W, Song PX, Carpenter L, Steinberg J, Cardozo LJ (2020) A behavioral intervention can decrease asthma exacerbations in older adults. Annals of Allergy, Asthma & Immunology 124, 248-253.e3.
| Google Scholar | PubMed |
Barton C, Proudfoot J, Amoroso C, Ramsay E, Holton C, Bubner T, Harris M, Beilby J (2009) Management of asthma in Australian general practice: care is still not in line with clinical practice guidelines. Primary Care Respiratory Journal 18, 100-105.
| Crossref | Google Scholar | PubMed |
Bonini M, Di Paolo M, Bagnasco D, Baiardini I, Braido F, Caminati M, Carpagnano E, Contoli M, Corsico A, Del Giacco S, Heffler E, Lombardi C, Menichini I, Milanese M, Scichilone N, Senna G, Canonica GW (2020) Minimal clinically important difference for asthma endpoints: an expert consensus report. European Respiratory Review 29(156), 190137.
| Crossref | Google Scholar | PubMed |
Bowatte G, Lodge C, Lowe AJ, Erbas B, Perret J, Abramson MJ, Matheson M, Dharmage SC (2015) The influence of childhood traffic-related air pollution exposure on asthma, allergy and sensitization: a systematic review and a meta-analysis of birth cohort studies. Allergy 70, 245-256.
| Crossref | Google Scholar | PubMed |
Broglio K (2018) Randomization in clinical trials: permuted blocks and stratification. JAMA 319, 2223-2224.
| Crossref | Google Scholar | PubMed |
Carvalho Coelho AC, Barretto Cardoso LS, Souza-Machado Cd, Souza-Machado A (2016) The impacts of educational asthma interventions in schools: a systematic review of the literature. Canadian Respiratory Journal 2016, 1-14.
| Crossref | Google Scholar |
Clark NM, Mitchell HE, Rand CS (2009) Effectiveness of educational and behavioral asthma interventions. Pediatrics 123, S185-S192.
| Crossref | Google Scholar | PubMed |
Cochrane MG, Bala MV, Downs KE, Mauskopf J, Ben-Joseph RH (2000) Inhaled corticosteroids for asthma therapy: patient compliance, devices, and inhalation technique. Chest 117, 542-550.
| Crossref | Google Scholar | PubMed |
Dick S, Friend A, Dynes K, Alkandari F, Doust E, Cowie H, Ayres JG, Turner SW (2014a) A systematic review of associations between environmental exposures and development of asthma in children aged up to 9 years. BMJ Open 4, e006554.
| Crossref | Google Scholar |
Dick S, Doust E, Cowie H, Ayres JG, Turner S (2014b) Associations between environmental exposures and asthma control and exacerbations in young children: a systematic review. BMJ Open 4, e003827.
| Crossref | Google Scholar | PubMed |
Ducharme FM, Dell SD, Radhakrishnan D, Grad RM, Watson WTA, Yang CL, Zelman M (2015) Diagnosis and management of asthma in preschoolers: a Canadian Thoracic Society and Canadian Paediatric Society position paper. Paediatrics & Child Health 20, 353-361.
| Crossref | Google Scholar | PubMed |
Dunbar-Jacob J, Erlen JA, Schlenk EA, Ryan CM, Sereika SM, Doswell WM (2000) Adherence in chronic disease. Annual Review of Nursing Research 18, 48-90.
| Google Scholar | PubMed |
Eakin MN, Rand CS (2012) Improving patient adherence with asthma self-management practices: what works? Annals of Allergy, Asthma & Immunology 109, 90-92.
| Crossref | Google Scholar | PubMed |
Gibson PG, Coughlan J, Wilson AJ, Abramson M, Bauman A, Hensley MJ, Walters EH (2000) Self-management education and regular practitioner review for adults with asthma. Cochrane Database of Systematic Reviews 2002, Cd001117.
| Crossref | Google Scholar |
Gillette C, Rockich-Winston N, Kuhn JBA, Flesher S, Shepherd M (2016) Inhaler technique in children with asthma: a systematic review. Academic Pediatrics 16, 605-615.
| Crossref | Google Scholar | PubMed |
Hollenbach JP, Cloutier MM (2015) Childhood asthma management and environmental triggers. Pediatric Clinics of North America 62, 1199-1214.
| Crossref | Google Scholar | PubMed |
Horak F, Doberer D, Eber E, Horak E, Pohl W, Riedler J, Szépfalusi Z, Wantke F, Zacharasiewicz A, Studnicka M (2016) Diagnosis and management of asthma – statement on the 2015 GINA guidelines. Wiener klinische Wochenschrift 128, 541-554.
| Crossref | Google Scholar | PubMed |
Janssens T, Ritz T (2013) Perceived triggers of asthma: key to symptom perception and management. Clinical & Experimental Allergy 43, 1000-1008.
| Crossref | Google Scholar | PubMed |
Jenkins CR, Chang AB, Poulos LM, Marks GB (2009) Asthma in Indigenous Australians: so much yet to do for Indigenous lung health. Medical Journal of Australia 190(10), 530-531.
| Crossref | Google Scholar | PubMed |
Lau N, Norman A, Smith MJ, Sarkar A, Gao Z (2018) Association between traffic related air pollution and the development of asthma phenotypes in children: a systematic review. International Journal of Chronic Diseases 2018, 1-12.
| Crossref | Google Scholar |
Mensah GA, Kiley JP, Gibbons GH (2018) Generating evidence to inform an update of asthma clinical practice guidelines: perspectives from the National Heart, Lung, and Blood Institute. Journal of Allergy and Clinical Immunology 142, 744-748.
| Crossref | Google Scholar | PubMed |
Mims JW (2015) Asthma: definitions and pathophysiology. International Forum of Allergy & Rhinology 5, S2-S6.
| Google Scholar |
Mosnaim GS, Pappalardo AA, Resnick SE, Codispoti CD, Bandi S, Nackers L, Malik RN, Vijayaraghavan V, Lynch EB, Powell LH (2016) Behavioral interventions to improve asthma outcomes for adolescents: a systematic review. The Journal of Allergy and Clinical Immunology: In Practice 4, 130-141.
| Google Scholar | PubMed |
Mosnaim GS, Akkoyun E, Eng J, Shalowitz MU (2017) Behavioral interventions to improve asthma outcomes: a systematic review of recent publications. Current Opinion in Allergy & Clinical Immunology 17, 194-200.
| Crossref | Google Scholar | PubMed |
National Asthma Council Australia (2015) The hidden cost of asthma. Deloitte access economics. Available at https://www.nationalasthma.org.au/living-with-asthma/resources/health-professionals/reports-and-statistics/the-hidden-cost-of-asthma-2015
National Asthma Council Australia (2022a) Asthma action plans. National Asthma Council Australia. Available at https://www.nationalasthma.org.au/health-professionals/asthma-action-plans/asthma-action-plan-library [Accessed 28 September 2022]
National Asthma Council Australia (2022b) How-to videos. National Asthma Council Australia. Available at https://www.nationalasthma.org.au/living-with-asthma/how-to-videos [Accessed 29 September 2022]
Nucleus Medical Media (2022) Asthma. Nucleus Medical Media. Available at https://nmal.nucleusmedicalmedia.com/view-item?ItemID=75489 [Accessed 29 September 2022]
Papi A, Brightling C, Pedersen SE, Reddel HK (2018) Asthma. The Lancet 391, 783-800.
| Crossref | Google Scholar | PubMed |
Price D, Roche N, Virchow JC, Burden A, Ali M, Chisholm A, Lee AJ, Hillyer EV, Von Ziegenweidt J (2011) Device type and real-world effectiveness of asthma combination therapy: an observational study. Respiratory Medicine 105, 1457-1466.
| Crossref | Google Scholar | PubMed |
Reddel HK, Hurd SS, FitzGerald JM (2014) World Asthma Day. GINA 2014: a global asthma strategy for a global problem. The International Journal of Tuberculosis and Lung Disease 18, 505-506.
| Crossref | Google Scholar | PubMed |
Reddel HK, Sawyer SM, Everett PW, Flood PV, Peters MJ (2015) Asthma control in Australia: a cross-sectional web-based survey in a nationally representative population. Medical Journal of Australia 202, 492-496.
| Crossref | Google Scholar | PubMed |
Riera A, Ocasio A, Tiyyagura G, Thomas A, Goncalves P, Krumeich L, Ragins K, Trevino S, Vaca FE (2017) A web-based educational video to improve asthma knowledge for limited English proficiency Latino caregivers. Journal of Asthma 54, 624-631.
| Crossref | Google Scholar | PubMed |
Schatz M, Kosinski M, Yarlas AS, Hanlon J, Watson ME, Jhingran P (2009) The minimally important difference of the Asthma Control Test. Journal of Allergy and Clinical Immunology 124, 719-723.e1.
| Crossref | Google Scholar | PubMed |
Shah RF, Gupta RM (2017) Video instruction is more effective than written instruction in improving inhaler technique. Pulmonary Pharmacology & Therapeutics 46, 16-19.
| Crossref | Google Scholar | PubMed |
Shahunja KM, Sly PD, Begum T, Biswas T, Mamun A (2021) Family, neighborhood and psychosocial environmental factors and their associations with asthma in Australia: a systematic review and meta-analysis. Journal of Asthma 12, 2539-2552.
| Crossref | Google Scholar |
Sleath B, Ayala GX, Gillette C, Williams D, Davis S, Tudor G, Yeatts K, Washington D (2011) Provider demonstration and assessment of child device technique during pediatric asthma visits. Pediatrics 127, 642-648.
| Crossref | Google Scholar | PubMed |
Stanescu S, Kirby SE, Thomas M, Yardley L, Ainsworth B (2019) A systematic review of psychological, physical health factors, and quality of life in adult asthma. NPJ Primary Care Respiratory Medicine 29, 37.
| Crossref | Google Scholar | PubMed |
To T, Stanojevic S, Moores G, Gershon AS, Bateman ED, Cruz AA, Boulet L-P (2012) Global asthma prevalence in adults: findings from the cross-sectional world health survey. BMC Public Health 12, 204.
| Crossref | Google Scholar | PubMed |
Tripepi G, Chesnaye NC, Dekker FW, Zoccali C, Jager KJ (2020) Intention to treat and per protocol analysis in clinical trials. Nephrology (Carlton) 25, 513-517.
| Crossref | Google Scholar | PubMed |
Twisk J, Bosman L, Hoekstra T, Rijnhart J, Welten M, Heymans M (2018) Different ways to estimate treatment effects in randomised controlled trials. Contemporary Clinical Trials Communications 10, 80-85.
| Crossref | Google Scholar |
Urek MC, Tudorić N, Plavec D, Urek R, Koprivc-Milenović T, Stojić M (2005) Effect of educational programs on asthma control and qualitiy of life in adult asthma patients. Patient Education and Counseling 58, 47-54.
| Crossref | Google Scholar | PubMed |
Yang IV, Lozupone CA, Schwartz DA (2017) The environment, the epigenome, and asthma. Clinical Immunology 140, 14-23.
| Google Scholar |
