July 2008-Women With Asthma Participating in Educational Phone Intervention
Study Reveals Women Asthmatics who participated in an Educational Phone Counseling Intervention Experienced Improved Health and Less Symptoms
Ann Arbor, Michigan - Women with asthma who received education and phone counseling about how to manage their disease experienced fewer symptoms, improved their quality of life and had fewer unscheduled doctor visits, a first-of-its-kind study conducted by the Center for Managing Chronic Disease (CMCD) at the University of Michigan has shown.
The study's counseling program is the first to systematically help women observe whether their symptoms worsen at points during their menstrual cycle, during sexual activity, with the use of contraceptives or estrogen replacement therapy, when cleaning the house, caring for family pets, using cosmetics or fragrances.
"Women are twice as likely to have asthma then men and almost always experience greater problems with the disease," said Noreen Clark, director of the University of Michigan's Center for Managing Chronic Disease.
"Asthma symptoms may worsen for as many as 30% to 40% of women during their menstrual cycle which is why this revolutionary study focused on recognizing the role of sex and gender in the disease. This research suggests that if women receive support and are educated about how to deal with their symptoms they can enjoy a better life," she added.
According to CMCD researchers if women are taught how to recognize gender-based triggers that bring on or worsen asthma, the severity of their symptoms decreased as did trips to the emergency department. For instance,
• Women who received phone counseling (the intervention group) had a 28% decrease in nighttime symptoms, which are often considered a sign of more serious asthma, compared with only a 1% decrease among women in the control group.
• The intervention group had 49% fewer unscheduled doctor visits and 41% fewer scheduled doctor visits compared to the control group who had decreases of 30% and 34%, respectively.
• The intervention group had a 9% decrease in those who reported being bothered by asthma during sexual activity, compared to a 0.3% decrease in the control group.
• The percentage of the intervention group that noticed asthma changes during their menstrual cycle increased almost 15% and those who noticed asthma changes when having PMS increased over 6%, compared to a decrease of 4% and a decrease of 4.5% in the comparison group, respectively.
Researchers looked at 808 asthma patients, 18 years of age or older, who experienced a presence of symptoms over the prior 12 months. All received care at participating University of Michigan asthma-related clinics and had no extenuating medical or mental conditions.
Women in the intervention group received the "Women Breathe Free" program, a multiple-component behavioral education program delivered by a nurse health educator through a series of telephone counseling sessions, in which women were introduced to a self-regulatory problem-solving process.
Women in the control group did not receive the educational program and received routine care from a participating asthma clinic.
Women in the intervention group worked with a nurse to set personal goals and then tailored a step-by-step action plan for addressing problems before they occurred. The women were each mailed an educational kit containing a workbook, a list of sex and gender-related asthma concerns, diaries and a peak flowmeter with an instructional videotape. In the first month, they participated in a 45-minute counseling session where they were asked to use the peak flow meter and the diary as observational tools to monitor symptoms and behaviors for a period of one month.
Following the month of self-observation, the women in the program received a total of four 30-min to 45-min telephone counseling session at two-week intervals, teaching women the problem-solving processes. A checklist was mailed in after the fifth session, along with a final check-up call. Data was collected over the phone one year later.
"Most women have the primary responsibility for child care and household management, in addition to their full time jobs but they have not considered the way in which being female influences their asthma. Using this type of intervention - telephone counseling that includes exploration of sex and gender related asthma triggers- allows women to work at their own pace, figure out what makes their asthma worse and develop good management strategies," added Clark. "Remarkably, strategic counseling from the nurse encouraged women to meet their personal goals and keep asthma under better control."
The research was funded by a grant from the National Heart, Lung and Blood Institute. The study was completed in 2007 and was published in the medical journal CHEST (2007). For more information on this project, please visit: http://cmcd.sph.umich.edu/women-with-asthma.html
The Center for Managing Chronic Disease at the University of Michigan aims to build the capacity for effective chronic disease prevention and management. Its focus is people at risk with emphasis on the most vulnerable and those who can help them--families, clinicians, communities, and system. It conducts innovative research and disseminates results that can help to change policy and practice.
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