State of the art in asthma education: the US experience.

Formal development of asthma education programs began in the early 1970s. More powerful inhaled medications had become available, yet their benefits were not being fully realized.' Patients' technique in using metered-dose inhalers, upon which so much of the current pharmacologic management depends, was seriously inadequate.2'3 High rates of nonadherence to medication regimens were documented for several chronic health problems, and adherence was poorer for more complex regimens and for medications that had to be used when the person was not having symptoms4-both of which were typical of asthma regimens. Environmental control practices of patients were notoriously problematic and, although somewhat less prevalent than among nonasthmatics, active smoking was, and is, an issue for many persons with asthma. These observations suggested that the asthma education occurring in the course of clinical contacts was not as effective as it needed to be. Recognition of the need for asthma patients to better understand their condition and take a more active role in its management also stemmed from a growing interest in a variety of behavioral factors in the etiology and management of health problems and a recognition of the social and economic burden of chronic illnesses. These factors led to several early efforts to develop more systematic asthma education programs: (1) an emergency room educational intervention by Maiman and colleagues;5 (2) the educational and rehabilitation efforts of Thomas Creer at the Children's Asthma Research Institute/National Asthma Center in Denver;6 (3) the development of the booklet Teaching My Parents About Asthma by Parcel et al;7 and (4) the Buffalo, NY, family asthma program.8 Development of asthma education programs was given impetus in the mid-1970s by the National Heart, Lung, and Blood Institute (NHLBI) when it issued a request for applications to "develop and evaluate self-management systems for childhood 94302 asthma." The following four programs for parents and children were developed and tested: (1) Open Airways by investigators at Columbia University;9 (2) Living with Asthma at the National Asthma Center;10 and (3) AIR POWER and AIR WISE at the Ameri-can Institutes for Research."1"12 The evaluations were published in the scientific literature. In addition, the NHLBI also published all four programs and fostered their dissemination through regional workshops throughout the United States. In this same period, other programs were developed, such as Asthma Care Training (ACT) for Kids developed by Lewis et al,13 the office-based program of Fireman et al,'4 and the American Lung Association's (ALA) …