Effect of Self-Regulatory Education on Women With Asthma

Over 9% of women in the United States have asthma compared to 5% of men.  Asthma has a differential impact on women.  During the last decade, the increase in the asthma mortality rate for men was 34%, whereas for women it was 59%.  Women consistently have higher rates of clinic visits, hospital admissions, and readmissions for asthma than men (1-3). 

Reports in the literature are beginning to describe differences in etiology, natural history, and asthma management needs that may be attributable to the sex or gender role of the patient.

Studies suggest that asthma symptoms may worsen for as many as 30% to 40% of women during menses (4-7).  Cough and breathlessness are more severe in women with menstrual-linked asthma, and these patients may exhibit a decrease in their peak expiratory flow rate (PEFR) (6, 8).  Women with menstrual-linked asthma have more visits to the emergency department (ED) and more hospitalizations and they require extra medication during the premenstrual and/or menstrual weeks (4, 7).  Women with asthma on estrogen replacement therapy (ERT) have increased risk of asthma symptoms (9, 10) and decreased peak flow requiring more inhaled bronchodilators (11, 12).  One-third of pregnant women with asthma experience a worsening of asthma symptoms during pregnancy (13).

Within most cultures, women have primary responsibility for child care and household management.  Hence, they are exposed to many potential asthma triggers (14, 15).  Allergens including dust mites, fungi, molds, and yeasts may be problematic for some women (14-16). Sensitizing agents such as household sprays, cleaning materials, perfumes, scented personal care products, cosmetics, and other products have been reported as triggers (17).

To date no rigorously evaluated intervention has focused on the particular problems that women face in the management of asthma.  The overall aim of the project was to evaluate an innovative educational intervention using telephone counseling based on self-regulation theory designed to address a problem heretofore overlooked in asthma self-management education: the unique needs of adult female patients(n=808).  Criteria for recruitment of all study participants were: 1) 18 yeas of age or older; 2) diagnosis of asthma by a University of Michigan Health System physician, 3) presence of active symptoms in the past 12 months, 4) enrolled as a patient in one of the participating asthma related clinics, 5) no extenuating medical or mental conditions. 

A randomized controlled design utilizing an intervention group and a usual care control group was conducted.  A total of 808 respondents who returned the completed consent forms by mail provided baseline data prior to randomization.  Women in the intervention group received the ‘Women Breathe Free' program (WBF).  WBF is a multiple-component behavioral education program delivered by a nurse health educator through telephone counseling.  It is based on social cognitive theory.  Women were introduced to a self-regulatory problem-solving process.   Self-reported recall data have been collected by telephone interview. 

The results of 12 months follow-up data analysis indicated that women in the treatment group had significantly greater reduction of nighttime symptoms, ED visits and unscheduled and scheduled office visits for asthma compared to women in the control group.  They also were more likely than controls to notice asthma symptoms related to their menstrual cycle and/or when they had PMS.  They reported a greater reduction in problems associated with sexual activity at both 12 and 24 months follow-up time points.  Compared with controls, women in the treatment group had great improvement in quality of life and self-confidence at both follow-ups. Data analysis is continuing. 

There are implications for clinical practice in these findings.  Consideration of women's particular perspective and experience managing asthma and the sex and gender related challenges they face appear to enrich a management intervention.  Attention to these areas when counseling patients and their inclusion in programs offered in the clinical setting could enhance asthma outcomes for female patients. 

Project-related Publications: 

Clark, N.M., Gong, M., Wang, S.J., Xinhong, L., Bria, W., Johnson, T.A. A randomized trial of a self-regulation intervention for women with asthma.  Chest, 132(1): 88-97, May 2007.  

Project-related Presentations: 

Clark, N.M., Gong, M., Valerio, M., Wang, S., Bria, W., Johnson, T. Women's self-management of asthma.  ALA/ATS International Conference, Orlando, FL, May 2004 (poster session).

For more information, contact Molly Gong at mgong@umich.edu