Chest
Volume 132, Issue 1, July 2007, Pages 88-97
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ORIGINAL RESEARCH
ASTHMA
A Randomized Trial of a Self-Regulation Intervention for Women With Asthma

https://doi.org/10.1378/chest.06-2539Get rights and content

Background:

Women with asthma have greater mortality and morbidity than men in the United States. To date, there has been no rigorous evaluation of an intervention focused on the particular problems in asthma management faced by women. This study was a randomized clinical trial of a self-regulation, telephone counseling intervention emphasizing women's concerns, and sex and gender role factors in their management of asthma.

Methods:

A total of 808 women with diagnosed asthma were randomly assigned to the intervention group or a usual-care control group, including conventional asthma education. Interviews and medical record data were collected to assess psychosocial factors, and the behavioral factors of functioning, quality of life, symptoms, and health-care use at baseline and the subsequent 1 year. Generalized estimating equations, identity link, logit link, and log link were employed to analyze the data.

Results:

Compared to control subjects, the women receiving treatment had greater annual reductions in the average number of nights with asthma symptoms (p = 0.04), days of missed work/school (p = 0.03), emergency department visits (p = 0.04), unscheduled office visits (p = 0.01), and scheduled office visits (p = 0.04). They had greater recognition of asthma symptoms during the menstrual cycle (p = 0.0003), had decreased asthma symptoms with sexual activity (p = 0.008), and had greater improvement in quality of life (p = 0.0005), self-regulation (p = 0.03), and self-confidence to manage asthma (p = 0.001).

Conclusion:

The intervention improved women's clinical status, functioning, quality of life, and health-care use. A program with a focus on asthma management problems particular to women can significantly assist female asthma patients.

Section snippets

Study Design and Sample

A random controlled study design was employed using two groups of female patients at the University of Michigan Health System (UMHS) who met the study criteria. Because a range of factors was expected to influence outcomes beyond asthma severity, the decision was made not to match women in the two groups with respect to disease severity. Patients were randomly assigned to an intervention group or a usual-care group. Usual care within the UMHS comprises treatment based on National Asthma

Randomization Status

Table 2 shows that there were no statistically significant differences between the intervention and control groups at baseline for any demographic variable, for the percentage of women from specialty clinics or for medication use, and for the asthma severity classification based on nighttime symptoms when comparing the four categories of asthma severity (ie, mild intermittent, mild, moderate, and severe persistent) separately. As noted, when all women reporting persistent asthma were compared

Discussion

To the investigators' knowledge, this is the first study to assess the effect on health outcomes of an asthma self-regulation intervention specifically addressing the perspective of female patients and their particular sex role-related and gender role-related management challenges. Symptom reduction is an important goal in asthma control, and the findings illustrate that the intervention significantly improved nighttime symptoms for program participants, but it had no significant effect on

Conclusion

Women in the treatment group receiving education focused on the particular management problems of a woman with asthma exhibited significant improvements in their symptoms, health-care use, quality of life, days of missed work or school, levels of self-regulation, and their self-confidence to manage asthma compared to women receiving conventional asthma education 1 year subsequent to the completion of the program.

There are implications for clinical practice in these findings. The consideration

ACKNOWLEDGMENT

The authors would especially like to thank Jimmy Yu, Martha DeRoeck, Jane Burton, and Susan Dara for their contributions.

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    The research was supported by grant 1 R18 HL60884–01 from the Division of Lung Diseases of the National Heart, Lung, and Blood Institute.

    The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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