Improving Patient Outcomes with Tools for Asthma Self-Monitoring: A Review of the Literature

Despite recent advances in the therapeutic management of asthma, the prevalence, morbidity and mortality of this chronic disease continue to increase in most countries. The financial burden associated with asthma has received increasing scrutiny in the medical literature over the past two decades. In 1990, a study in the US demonstrated that all chronic disease conditions accounted for $US425 billion in medical care costs. These chronic conditions accounted for 96% of home care visits, 80% of hospital days, 69% of hospital admissions, 66% of doctor and 55% of emergency department visits, and 55% of pharmacy prescriptions. This has led to an increased demand for improved outpatient management of asthma, and patients are now monitoring their asthma and gathering data in the ambulatory setting. Self-monitoring tools for patients with diabetes mellitus and hypertension have grown in recent years, but technological advances for self-monitoring of patients with asthma have been slow over the past several decades. This article reviewed the literature on self-monitoring tools currently available for improving outcomes in the patient with asthma. These tools currently consist of written treatment plans, peak flow meters and metered-dose inhaler monitoring devices. Patient education and training in self-management involving self-monitoring of either symptoms or peak expiratory flow, in conjunction with education and a written treatment plan, appears to improve health outcomes for both children and adults with asthma. Education allowing patients with asthma or their caregivers to intervene and adjust medications under the guidance of a written treatment plan appears to be more effective than other forms of asthma self-management.