Self-Management, Autonomy, and Quality of Life in Asthma

¹ From the Asthma Management Service, John Hunter Hospital, Newcastle, Australia, and Year 2 Population Medicine Group, 91C, Faculty of Medicine, University of Newcastle, NSW, Australia

Study objective: Asthma management guidelines emphasize increased autonomy for asthmatics through patient education and patient-initiated action plans. The aim of this study was to examine autonomy, as reflected in the preferences of asthmatic subjects for decision making and their preferences for information seeking. The results were related to quality of life in asthma.

Subjects: One hundred twenty-three adults with asthma.

Design: Questionnaire-based cross-sectional analytic survey.

Setting: Eighty-five subjects were recruited from community pharmacies at the point of sale of albuterol inhalers for asthma and compared with 38 subjects recently hospitalized for acute severe asthma.

Measurements: Asthma-related quality of life, autonomy preferences questionnaire.

Results: The subjects in both groups had a mild-to-moderate quality of life impairment in all domains that was greater in the posthospitalization group (p<0.05). Both groups expressed strong preferences for information concerning their condition (92se 0.8, 91se 1.1, out of a possible 100). Subjects did not prefer to make decisions alone about the management of asthma exacerbations (51.0se 1.2, 52.5 se2.0, out of a possible 100). As the severity of the asthma exacerbation increased, the desire to make decisions decreased (p<0.05). Older subjects expressed less desire for decision making than younger subjects. Self-management autonomy was not correlated with quality of life in asthma.

Conclusions: We conclude that while asthmatics have strong desires to be informed about their illness, they do not wish to be the prime decision makers during an exacerbation. These findings have implications for the success of self-management programs and action plans.

Key Words: asthma • autonomy • ethics • quality of life • decision making

Submitted on April 4, 1994
Accepted on August 12, 2007

This article has been cited by other articles:

				A-L Caress, K Beaver, K Luker, M Campbell, and A Woodcock Involvement in treatment decisions: what do adults with asthma want and what do they get? Results of a cross sectional survey Thorax, March 1, 2005; 60(3): 199 - 205. [Abstract] [Full Text] [PDF]

				R J Adams, B J Smith, and R E Ruffin Patient preferences for autonomy in decision making in asthma management Thorax, February 1, 2001; 56(2): 126 - 132. [Abstract] [Full Text]

				R. J Adams, B. J Smith, and R. E Ruffin Factors associated with hospital admissions and repeat emergency department visits for adults with asthma Thorax, July 1, 2000; 55(7): 566 - 573. [Abstract] [Full Text]

				A. Lahdensuo Guided self management of asthma---how to do it BMJ, September 18, 1999; 319(7212): 759 - 760. [Full Text]

				H Moudgil and D Honeybourne Differences in asthma management between white European and Indian subcontinent ethnic groups living in socioeconomically deprived areas in the Birmingham (UK) conurbation Thorax, June 1, 1998; 53(6): 490 - 494. [Abstract] [Full Text]