Introduction to self-management of asthma programs.

I nthe past decade there has been a renaissance of scientific interest and research into health education and programs of self-management, especially as they may apply to the control of chronic disabling diseases. Heightened public awareness of the precise role that individuals may play in promoting their own health has increased during this time through media exposure and improved patterns of life-style, which are presumed to be associated with enhanced quality of life and better health. It has not always been possible, however, to translate gains made by healthy people into similar progress for persons with chronic illness. In the middle 1970s research support became available for studies in a variety of areas. Such studies shared common goals and included exploration of the means and methods of modifying behavior patterns in individuals in order that they might improve the quality of their lives and take advantage of advances in modern medicine. Changes observed to date include those related to our enhanced understanding of the harmful effects of cigarette smoking and improved compliance in taking medication to control hypertension. On the basis of preliminary evidence that children with asthma could learn effective ways of managing their disease with reduced reliance upon the health care system, the National Heart, Lung and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases (NIAID), as well as other federal and non-federal funding agencies, have helped to promote the development of programs whose goals are to encourage and facilitate the selfmanagement of asthma. These programs have included educational reading materials and other learning aids and are aimed not only at children with asthma, but also at the parents, teachers and other health practitioners within the community. A variety of programs were reviewed at a meeting entitled Self-Management Educational Programs for Childhood Asthma, held in Los Angeles in June, 1981 and sponsored by the NIAID in conjunction with the Asthma and Allergy Foundation of America and the Center for Interdisciplinary Research on Immunologic Diseases at the University of California, Los Angeles.’ Following this initial meeting, it became apparent that a wide variety of programs were not only available, but probably desirable in order to accommodate the needs of many different localities and groups of patients. However, the mere availability of a program, even if proven effective, did not mean acceptance. Another task remained, namely: to provide sufficient information in a critical fashion that would permit the recipient of potential programs not only to understand their content, but also their implications in potentially changing patient and physician behavior. Thus, in 1983, NIAID in cooperation with the NHLBI jointly sponsored a follow-up workshop on SelfManagement of Childhood Asthma’ which was aimed at exploring in greater depth the implications of such programs. This workshop, therefore, focused upon issues other than the straighiforward presentation of available programs. For example, how would such programs impact upon traditional physician patient relationships, who would bear the cost, who should receive such services, and what would be appropriate settings. It was apparent that the presence of self-management programs represented the beginning of new thought processes on the part of health providers in accomplishing time honored goals. Subsequent to this, the NHLBI, in conjunction with the American Lung Association, has begun a series of workshops aimed at providing model programs throughout the country. Furthermore, the Asthma and Allergy Foundation of America has also begun to disseminate Self-Management of Asthma programs in selected communities across the United States. Health professionals throughout the United States who care for persons with asthma are in the process of becoming exposed to a variety of self-management approaches. Most are currently aimed at children, some are being developed for adults, and Spanish language programs are being tested. To those individual health care practitioners who have somehow avoided these burgeoning efforts, we now present an opportunity to become intimately familiar with available activities, their basis and rationale and their mechanism of implementation. The following articles review various aspects of the topic and programs.