Please select the eligibility criteria that correspond to the clinical trial below.
Title: Asthma in a Decentralized Patient Population: Is Traditional Disease Management Enough? A Randomized, Controlled Trial Comparing Traditional Care to Two Systems of Disease Management for a Decentralized Population of Patients in South Texas
Brief Summary: This is a health services demonstration project that evaluates three methods of health care delivery for the management of individuals with symptoms of asthma. This study will evaluate the impact of a telephonic asthma disease management process, with and without a home intervention program, on preventing asthma-related morbidity through patient/family asthma education.

The investigators' central thesis is that comprehensive clinical disease management protocols for the management of asthma will improve clinical outcomes; reduce fiscal resource consumption; and improve both patient satisfaction and patient quality of life. Additionally, individualized, in-home patient education and environmental assessment, when added to the telephonic protocol, will further improve these measures. However, incremental improvement will vary according to the population's access to care.


Options:
A: Inclusion: Asthma not well-controlled; doctor-diagnosed asthma; currently taking asthma medications; 12 % and 200ml increase in FEV1 after 2 puffs of an inhaled short-acting -agonist (SABA) bronchodilator ; 2 or more control problems identified using the ATAQ asthma control instrument; 18-70 years of age; willing to be randomized to one of the three treatment arms and to participate in follow-up for 2 years; Kaiser Permanente member for 1 year

Exclusion: Mild intermittent asthma, defined as either seasonal asthma or (daytime asthma symptoms \<2x/week and nocturnal symptoms \<2x/month and no use of controller medications); under the ongoing care of an allergist or pulmonologist; regular use of oral corticosteroids; currently receiving case-management for their asthma; unable to speak, read or understand English; planning to leave the catchment area within the next two years
B: Inclusion Criteria:

1. Age 18-80
2. Class II through IV asthma sufferers will be included (mild persistent; moderate persistent; severe persistent).
3. Ability to read and write at minimum fifth grade level
4. Willing to comply with study instructions and sign an informed consent
5. English-speaking

Exclusion Criteria:

1. Pregnancy or lactation
2. Concurrent serious or life-threatening illness as determined by clinical judgment
3. Psychiatric disorder as determined by clinical judgment.
4. Inability to understand or follow the instructions associated with the clinical study as determined by clinical judgment.
5. Fish allergy or history of adverse reaction to vitamin C or fish oil as determined by clinical history.
C: * Kaiser Health Care Program member for more than 1 yr.
* Site: Portland, OR, Honolulu, HI, San Francisco, Oakland, or Richmond, CA.
* Confirmed diagnosis of persistent asthma with currently prescribed medications; no daily or alternate daily oral corticosteroid
* Evidence of poorly controlled asthma: score of \>=1 on ATAQ asthma control questionnaire1 and either overuse of rescue medication vs. controller medications and/or recent emergency visit or hospitalization for asthma
* COPD not the primary lung disease diagnosis
* Regular use of Inhaled Corticosteroid (ICS) and current/ex-smokers: \>= 8% increase in FEV1 post-bronchodilator; if no routine ICS use +/- smoking HX: \>= 12% increase required; non-smokers using ICS regularly not required to reverse
D: Inclusion Criteria:

* Physician diagnosis of asthma
* One or more of the following:

  * Acute visit with the primary diagnosis of asthma within the previous 6 months. (Includes visits to physician's office, emergency department, or any other health care facility.); OR
  * Three or more refills for inhaler medicine in the past 6 months, based on review of pharmaceutical records; OR
  * Diagnosis of asthma based on asthma symptoms and pulmonary function testing.

Exclusion Criteria:

* Other lung disease(s) with a possible reactive component (i.e. chronic obstructive pulmonary disease \[COPD\])
* Any diagnosis requiring chronic systemic steroids
* Enrollment in any other asthma disease management program
* Pregnancy
* Plan to reside at current residence for less than 12 months.

Answer: D