Effectiveness of self-management programs for obstructive respiratory problems

Obstructive respiratory problems, referring essentially to asthma and chronic obstructive pulmonary disease (COPD), have a major impact on the population of Canada. Managing them is primarily achieved by preventing a deterioration of respiratory function through self-management programs. Educational programs consist of three general approaches: understanding asthma; self-monitoring of respiratory function; and an action plan. However, questions are still being raised concerning program effectiveness depending on the nature and severity of the respiratory problems.

 The involvement of the Agence d’Évaluation des Technologies et des Modes d’Intervention en Santé (AETMIS) stems from a request for evaluation made during the summer of 1999 by the Direction de la Santé Publique de Montréal-Centre. The Conseil d’évaluation des technologies de la santé, replaced un June 2000 by AETMIS, was asked to evaluate the effectiveness of the use of peak flow meters, by patients suffering from obstructive respiratory problems, in decreasing the number of emergency room visits. However, it was deemed appropriate to extend the analytical framework to include all obstructive respiratory problems so as to provide a more general overview.

In conclusion, AETMIS considers that, for the adult population, self-management programs for asthma are an accepted and effective way to decrease several indicators of morbidity. According to the experts, such programs should target patients who are failing to adequately control their disease. Program effectiveness for the pediatric population remains uncertain. Finally, for the patients with COPD, research is going on, but preliminary data from a Québec study suggest very promising results with regard to the effectiveness of this technology.