Bronşiyal astımda hasta eğitiminin hastalığın prognozu, solunum fonksiyonları ve yaşam kalitesine etkisi

Astım mortalite ve morbiditesindeki artışlar çok sayıda ulusal ve uluslararası tanı ve tedavi rehberleri hazırlanmasına neden olmuştur. Tüm kılavuzlarda, hasta eğitiminin astım tedavisinin mutlak bir parçası olması gerektiği vurgulanmaktadır. Bu çalışmanın amacı da, astımlılarda uygulanan eğitim programının hastalık hakkındaki bilgi düzeyine, inhaler kullanma becerisine, günlük yaşamlarına, solunum fonksiyonlarına ve yaşam kalitesine olan etkisini değerlendirmektir. Yirmibeş'i erkek toplam 91 astımlı hasta, hastalıkları ve kullandıkları ilaçlar hakkında bilgi verildikten sonra, PEF takiplerine dayalı atak tedavisinin öğretildiği 2 seanslık bir eğitim programına alındılar. Doksanbir hastanın 70'i eğitim programını tamamlarken, 21 hasta programı tamamlamadı. Başlangıç solunum fonksiyonları ölçülen hastalar eğitim programı öncesi hemen ve 1 yıl sonrasında hastalık hakkında bilgi, inhaler kullanma becerisi, semptomlar, acile başvuru, gece semptomları, hastaneye yatış, işe-okula gidilemeyen gün sayısı açısından anketlerle değerlendirildiler. Ayrıca eğitimini tamamlayan hastalar başlangıçta ve 1 yıl sonunda yaşam kalitesi açısından da değerlendirildiler. Sonuçlara bakıldığında eğitimi yarıda bırakan hastalarda hiçbir parametrede düzelme saptanmazken, eğitimi tamamlayan hastalarda hastalık hakkında bilgi ve inhaler kullanma becerilerinde 1 yıl sonunda bile anlamlı düzelmelerin (p< 0.001), %FEV1, PEF, %PEF ve PEF varyasyonunda anlamlı artışların (p< 0.05), hastaneye yatış ve gece semptom sayılarında ise anlamlı düşmelerin olduğu görüldü (sırasıyla p< 0.01, p< 0.005). Genel yaşam kalitesi skorunun da 1 yıl sonunda anlamlı arttığı belirlendi (p< 0.005). Bu sonuçlar astımda, PEF takibine dayalı tedavi planı içeren eğitim programının yararlı olduğunu desteklemiş, astım tedavisinin bir parçası olması gerektiğini göstermiştir.

The effect of patient education on prognosis, pulmonary functions and quality of life in asthmatic patients

To effectively manage asthma, reduce mortality and morbidity related to asthma, education programmes are recommended. The aim of this study was to evaluate the effects of a patient education programme on knowledge of the disease, pulmonary functions, social impacts and quality of life (QOL) in asthmatic patients. A total of 91 adult asthma patients (25 male, 66 female) were included in a asthma education programme; including information about the disease and medications, correct use of inhaling devices, regular measurement and documentation of peak expiratory flow rates (PEFR), preventation and treatment of asthmatic attacks with a peak flow based asthma self-management plan. After determining their baseline pulmonary functions patients answered questionnaires about their knowledge of disease, subjective measurements of asthma severity before the start of the programme, at the end of the programme and after a year. Their ability to use inhaling devices was also evaluated at the same occasions. QOL was determined before and 1 year after in 70 patients who have completed the programme. Education programme was seen to improve patients knowledge of asthma (p< 0.001) and their ability to use medications (p< 0.001) considerably with respect to the preeducation period even after a year in patients who completed the programme. After a year there was a significant improvement in FEV1 (p< 0.05) and PEF (p< 0.05), significant reduction in PEF variation (p< 0.05), hospital admission rates (p< 0.01), number of nights woken (p< 0.005). There was a general improvement in QOL score (p< 0.005). There were no significant changes in any parameter in patients who did not completed the programme. This evidence suggests that patient education including self-management skills are effective and must be a part of life long management of asthma.

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