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Martínez-González CL, Camargo Fajardo MCC, Martínez-Ortiz EJ, Segura-Medina P. A soft systems approach of asthma management in children based on therapeutic education and e-learning. Respir Med 2024; 230:107691. [PMID: 38844003 DOI: 10.1016/j.rmed.2024.107691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 06/03/2024] [Indexed: 06/13/2024]
Abstract
One of the most common respiratory chronic diseases is asthma, with 5-16 % of world prevalence. In chronic disease, prevention, diagnosis, management, and palliation are the strategies for a care model; the patient-self management is fundamental with the so-called therapeutic education (TE) to train the patient in the necessary skills. The challenge of TE grows when the patient is a child or a person with special needs, even more in public health care in low- and middle-income countries. This is a problematic human situation, that needs soft system thinking. In this research, the analytic hierarchy process was used to determine the perceived importance of the factors that affect children's asthma health care in a public health institution in Mexico. The soft systems methodology (SSM) was applied to learn about the disease self-management, in order to obtain activities models and an action plan. According to AHP, human resources and education were percived as the most important among the factors that affect children health care within the institution. The perceived importance of two main subfactors (human resources training and TE) was around 34 %, which emphasizes the need to generate strategies for the improvement of the education of patients and health care providers. In MSS, the rich vision, the CATWOE, the root definition, and an activities model were proposed, including the application of an instructional design methodology (ADDIE) for the development of learning objects of asthma for children. Desirable and feasible actions and recommendations include the update of the national clinical practice guides, the use of control measures such as the Asthma Control Test, and a daily asthma diary to register the daily status of the breathing capacity, the drug administration, and the potential trigger events. The proposed model can be used as part of a systemic patient-and-family centered approach for chronic care model (CCM), particularly in diseases unsuitable for prevention interventions.
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Affiliation(s)
- C L Martínez-González
- Programa de Posgrado en Ingeniería de Sistemas, SEPI ESIME-Z, Instituto Politécnico Nacional, Av. IPN S/N, CP. 07738, Mexico.
| | - M C C Camargo Fajardo
- Programa de Posgrado en Ingeniería de Sistemas, SEPI ESIME-Z, Instituto Politécnico Nacional, Av. IPN S/N, CP. 07738, Mexico
| | - E J Martínez-Ortiz
- Programa de Posgrado en Ingeniería de Sistemas, SEPI ESIME-Z, Instituto Politécnico Nacional, Av. IPN S/N, CP. 07738, Mexico
| | - P Segura-Medina
- Departamento de Investigación en Hiperreactividad Bronquial, Instituto Nacional de Enfermedades Respiratorias, CP. 14080, Mexico; Escuela de Medicina y Ciencias de la Salud, ITESM-CCM, CP. 14380, Mexico
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Juliá Benito JC, Moreno-Galarraga L, Bragado Alcaraz E, Asensi Monzó MT, Ortega Casanueva C, Moral L, Rodríguez Fernández-Oliva CR, Sanz Ortega J, Valdesoiro Navarrete L. Inhaled medications and inhalation chambers for childhood asthma. Spanish network of working groups on asthma in pediatrics (REGAP). An Pediatr (Barc) 2024; 100:123-131. [PMID: 38326156 DOI: 10.1016/j.anpede.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 12/26/2023] [Indexed: 02/09/2024] Open
Abstract
Asthma, the most prevalent chronic disease in pediatric age, continues to pose challenges in its management and treatment. National and international guidelines emphasize the importance of therapeutic education (TE) to achieve disease control. TE involves imparting knowledge and skills to the patient and their family, enhancing medication adherence, rectifying errors in inhalation technique, and tailoring treatment based on individual patient characteristics. It is essential for TE to be progressive, gradual, and personalized, spanning all levels of care. Training healthcare professionals in TE is crucial, particularly for pediatricians, who must also be aware of the extensive variability of available meds and inhalers and their respective age-specific indications. Addressing this need, the REGAP Group extensively reviewed inhalers currently available in Spain for pediatric asthma treatment. The review encompassed different inhalation systems and inhaled drugs used for pediatric asthma treatment. This review will be updated annually, providing information on medications, devices, inhalation chambers, indications, and financiation. The REGAP Group hopes that these tables will be a valuable help for pediatricians in their daily clinical practice and serve as an effective TE tool.
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Affiliation(s)
- Juan Carlos Juliá Benito
- Centro de Salud República Argentina, Valencia, Spain; Unidad de Alergia y Neumología Pediátrica, Hospital IMED, Valencia, Spain.
| | - Laura Moreno-Galarraga
- Neumología Infantil, Servicio de Pediatría, Hospital Universitario de Navarra, Pamplona, Spain
| | - Esther Bragado Alcaraz
- Unidad de Neumología y Alergia Pediátrica, Hospital Universitario Santa Lucia, Cartagena, Spain
| | | | | | - Luis Moral
- Unidad de Alergología y Neumología Pediátrica, Hospital General Universitario, Alicante, Spain
| | | | | | - Laura Valdesoiro Navarrete
- Unidad de Alergia, Neumología Pediátrica y Fibrosis Quística, Servicio de Pediatría, Hospital Universitario Parc Taulí, Sabadell, Barcelona, Spain
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Plaza Moral V, Alobid I, Álvarez Rodríguez C, Blanco Aparicio M, Ferreira J, García G, Gómez-Outes A, Garín Escrivá N, Gómez Ruiz F, Hidalgo Requena A, Korta Murua J, Molina París J, Pellegrini Belinchón FJ, Plaza Zamora J, Praena Crespo M, Quirce Gancedo S, Sanz Ortega J, Soto Campos JG. GEMA 5.3. Spanish Guideline on the Management of Asthma. OPEN RESPIRATORY ARCHIVES 2023; 5:100277. [PMID: 37886027 PMCID: PMC10598226 DOI: 10.1016/j.opresp.2023.100277] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
The Spanish Guideline on the Management of Asthma, better known by its acronym in Spanish GEMA, has been available for more than 20 years. Twenty-one scientific societies or related groups both from Spain and internationally have participated in the preparation and development of the updated edition of GEMA, which in fact has been currently positioned as the reference guide on asthma in the Spanish language worldwide. Its objective is to prevent and improve the clinical situation of people with asthma by increasing the knowledge of healthcare professionals involved in their care. Its purpose is to convert scientific evidence into simple and easy-to-follow practical recommendations. Therefore, it is not a monograph that brings together all the scientific knowledge about the disease, but rather a brief document with the essentials, designed to be applied quickly in routine clinical practice. The guidelines are necessarily multidisciplinary, developed to be useful and an indispensable tool for physicians of different specialties, as well as nurses and pharmacists. Probably the most outstanding aspects of the guide are the recommendations to: establish the diagnosis of asthma using a sequential algorithm based on objective diagnostic tests; the follow-up of patients, preferably based on the strategy of achieving and maintaining control of the disease; treatment according to the level of severity of asthma, using six steps from least to greatest need of pharmaceutical drugs, and the treatment algorithm for the indication of biologics in patients with severe uncontrolled asthma based on phenotypes. And now, in addition to that, there is a novelty for easy use and follow-up through a computer application based on the chatbot-type conversational artificial intelligence (ia-GEMA).
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Affiliation(s)
| | - Isam Alobid
- Otorrinolaringología, Hospital Clinic de Barcelona, España
| | | | | | - Jorge Ferreira
- Hospital de São Sebastião – CHEDV, Santa Maria da Feira, Portugal
| | | | - Antonio Gómez-Outes
- Farmacología clínica, Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, España
| | - Noé Garín Escrivá
- Farmacia Hospitalaria, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | | | | | - Javier Korta Murua
- Neumología Pediátrica, Hospital Universitario Donostia, Donostia-San, Sebastián, España
| | - Jesús Molina París
- Medicina de familia, semFYC, Centro de Salud Francia, Fuenlabrada, Dirección Asistencial Oeste, Madrid, España
| | | | - Javier Plaza Zamora
- Farmacia comunitaria, Farmacia Dr, Javier Plaza Zamora, Mazarrón, Murcia, España
| | | | | | - José Sanz Ortega
- Alergología Pediátrica, Hospital Católico Universitario Casa de Salud, Valencia, España
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Akca Sumengen A, Ocakci AF. Evaluation of the effect of an education program using cartoons and comics on disease management in children with asthma: a randomized controlled study. J Asthma 2023; 60:11-23. [PMID: 35175171 DOI: 10.1080/02770903.2022.2043358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this study was to determine the effect of an education program, the Health Promotion Program for Children with Asthma (HPPCA), on disease control and quality of life in children aged between 7 and 11 and diagnosed with asthma. The program was developed using cartoons and color-in materials and was based on the health promotion model developed by Nola J. Pender and brain-based learning theories. MATERIALS AND METHODS The sample of the study consisted of 74 children between the ages of 7 and 11 who presented to the respiratory diseases' unit of a university hospital in Istanbul. All participants were given basic asthma education by their physicians, and were then randomly assigned to a group that received the HPPCA program or a control group that received no further education. After the HPPCA education was applied to the experimental group alone, both groups were administered two post-tests as a follow-up and retest at the end of the first and fourth month after the intervention. The standardized Sociodemographic Question Form, the Childhood Asthma Control Test (C-ACT) and the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) were used for the follow-up. RESULTS The asthma control and quality of life scores of the children included in the experimental group were found to be significantly higher compared to the control group at the first- and fourth-month follow-ups (p<.001). The rate of school absenteeism decreased significantly in children who received HPPCA education at the first follow-up compared to the children who did not receive the education (p<.05). PRACTICE IMPLICATIONS The present study found that the HPPCA education, whose design was based on the health promotion model, and which was supported by cartoons in order to attract the attention of the children, was effective. The HPPCA was proven to create a sense of control over asthma and to improve the quality of life in the children. It is recommended that there be an asthma nurse in pediatric allergy and immunology outpatient clinics who can specifically provide an HPPCA. Further studies should be conducted to demonstrate the effectiveness of this program, which was examined in the present study for the first time with a randomized controlled method.HighlightsAsthma control is extremely important for the quality of life in children with asthma.Asthma education provided to school-age children yields the best results when new teaching techniques and multimedia content are used.Asthma education for children must be based on a good theoretical methodology.Children can best manage asthma when they learn about it directly.Asthma education conducted according to the guidelines is of great importance during the COVID-19 pandemic.
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Affiliation(s)
- Aylin Akca Sumengen
- Koc University Graduate School of Health Science, İstanbul, Turkey.,Yeditepe University Faculty of Health Science, Atesehir/Istanbul, Turkey
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Moral L, Asensi Monzó M, Juliá Benito JC, Ortega Casanueva C, Paniagua Calzón NM, Pérez García MI, Rodríguez Fernández-Oliva CR, Sanz Ortega J, Valdesoiro Navarrete L, Valverde-Molina J. Pediatric asthma: The REGAP consensus. An Pediatr (Barc) 2021; 95:125.e1-125.e11. [PMID: 34353777 DOI: 10.1016/j.anpede.2021.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/15/2021] [Indexed: 10/20/2022] Open
Abstract
Asthma is one of the main chronic diseases in childhood, due to its high prevalence and its social and health costs. This document is a summary of a consensus guideline approved by 6 Spanish pediatric societies related to asthma and endorsed by the Spanish Pediatric Association. Asthma is easily identifiable by clinical criteria in most patients. Spirometry and other tests are helpful for diagnosis, especially in atypical cases. Asthma exacerbation is a frequent manifestation of the disease and must be identified and treated promptly. When asthma symptoms are frequent and the quality of life is affected, maintenance treatment must be instituted to achieve control of the disease. Low-dose inhaled corticosteroids are effective and safe for long-term use. Education of the patient with asthma is essential for good control. The main reason for poor asthma control is non-compliance with treatment, either due to its erratic and insufficient administration, or due to poor application technique of inhaled drugs. If control is not obtained despite adequate treatment, the diagnosis must be reconsidered, as well as the factors or comorbidities that make control difficult. Other drugs can be added to avoid high doses of inhaled corticosteroids, notably montelukast or long-acting β2 adrenergic agonists. Severe or difficult-to-control asthma, which does not respond to the usual treatments, should be managed in specialized units.
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Affiliation(s)
- Luis Moral
- Unidad de Neumología y Alergología Pediátrica, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain.
| | | | | | | | | | | | | | - José Sanz Ortega
- Unidad de Alergia y Neumología Infantil, Hospital La Salud, Valencia, Spain
| | - Laura Valdesoiro Navarrete
- Unidad de Alergia, Neumología Pediátrica y Fibrosis Quística, Servicio de Pediatría, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - José Valverde-Molina
- Servicio de Pediatría, Hospital Universitario Santa Lucía, Cartagena, Murcia, Spain
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Moral L, Asensi Monzó M, Juliá Benito JC, Ortega Casanueva C, Paniagua Calzón NM, Pérez García MI, Rodríguez Fernández-Oliva CR, Sanz Ortega J, Valdesoiro Navarrete L, Valverde-Molina J. [Pediatric asthma: The REGAP consensus]. An Pediatr (Barc) 2021. [PMID: 33775581 DOI: 10.1016/j.anpedi.2021.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Asthma is one of the main chronic diseases in childhood, due to its high prevalence and its social and health costs. This document is a summary of a consensus guideline approved by 6 Spanish pediatric societies related to asthma and endorsed by the Spanish Pediatric Association. Asthma is easily identifiable by clinical criteria in most patients. Spirometry and other tests are helpful for diagnosis, especially in atypical cases. Asthma exacerbation is a frequent manifestation of the disease and must be identified and treated promptly. When asthma symptoms are frequent and the quality of life is affected, maintenance treatment must be instituted to achieve control of the disease. Low-dose inhaled corticosteroids are effective and safe for long-term use. Education of the patient with asthma is essential for good control. The main reason for poor asthma control is non-compliance with treatment, either due to its erratic and insufficient administration, or due to poor application technique of inhaled drugs. If control is not obtained despite adequate treatment, the diagnosis must be reconsidered, as well as the factors or comorbidities that make control difficult. Other drugs can be added to avoid high doses of inhaled corticosteroids, notably montelukast or long-acting β2 adrenergic agonists. Severe or difficult-to-control asthma, which does not respond to the usual treatments, should be managed in specialized units.
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Affiliation(s)
- Luis Moral
- Unidad de Neumología y Alergología Pediátrica, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España.
| | | | | | | | | | | | | | - José Sanz Ortega
- Unidad de Alergia y Neumología Infantil, Hospital La Salud, Valencia, España
| | - Laura Valdesoiro Navarrete
- Unidad de Alergia, Neumología Pediátrica y Fibrosis Quística, Servicio de Pediatría, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España
| | - José Valverde-Molina
- Servicio de Pediatría, Hospital Universitario Santa Lucía, Cartagena, Murcia, España
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Vaquero-Lozano P, Lassaletta-Goñi I, Giner-Donaire J, Gómez-Neira MDC, Serra-Batlles J, García-García R, Álvarez-Gutiérrez FJ, Blanco-Aparicio M, Díaz-Pérez D. [Asthma 2020 Nursing Consensus Document]. OPEN RESPIRATORY ARCHIVES 2021; 3:100079. [PMID: 37497358 PMCID: PMC10369614 DOI: 10.1016/j.opresp.2020.100079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 11/30/2020] [Indexed: 02/07/2023] Open
Abstract
Asthma is a chronic respiratory disease which presents with a risk of exacerbations. Good patient management and continuous monitoring are crucial for good disease control, and pharmacological and non-pharmacological interventions are essential for proper treatment. Nurses specialised in asthma can contribute to the correct management of asthmatic patients. They play a key role in diagnostic tests, administration of medication, and patient follow-up and education. This consensus arose from the need to address an aspect of asthma management that does not appear in the specific recommendations of current guidelines. This document highlights and updates the role of specialized nurses in the care and management of asthma patients, offering conclusions and practical recommendations with the aim of improving their contribution to the treatment of this disease. Proposed recommendations appear as the result of a nominal consensus which was developed during 2019, and validated at the beginning of 2020.
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Affiliation(s)
- Paz Vaquero-Lozano
- Servicio de Neumología, CEP Hermanos Sangro, Hospital General Universitario Gregorio Marañón, Madrid, España
| | | | - Jordi Giner-Donaire
- Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | | | - Joan Serra-Batlles
- Servicio de Neumología, Hospital Universitario de Vic, Barcelona, España
| | - Rocío García-García
- Servicio de Neumología, Hospital Universitario 12 de Octubre, Madrid, España
| | | | | | - David Díaz-Pérez
- Servicio de Neumología y Cirugía Torácica, Hospital Universitario Nuestra Señora de Candelaria, Sta. Cruz de Tenerife, España
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Montero M, Iraurgi I, Matellanes B, Montero JM. [Use of the reliable change index to evaluate the effectiveness of clinical interventions: Application of an asthma training program]. Aten Primaria 2015; 47:644-52. [PMID: 25700987 PMCID: PMC6983811 DOI: 10.1016/j.aprim.2014.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 12/02/2014] [Accepted: 12/03/2014] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To compare two methods for the evaluation of outcomes to assess effectiveness of a therapeutic intervention of a professional education program on asthma control. DESIGN A naturalistic, intervention study in which asthmatic patients were attended by clinicians (IG group) who Had taken part in a special education program and a control group (CG) that received medical assistance from clinicians still waiting to be trained. LOCATION Five urban Primary Care Health Centres of the same region. PARTICIPANTS From an initial sample of 100 patients, 76 formed the final sample for analysis. The study included 37 males and 39 females, aged between 18 and 65 years (M=41.2 years). The two study groups were found to be homogeneous except for the sex variable. INTERVENTION Training program for clinical treatment adherence. MAIN MEASUREMENTS Peak flow as spirometric index, and structured interview. STATISTICAL ANALYSIS The results were initially analysed using classical techniques based on robust ANOVA models, and then by calculating the Reliable Change Index (RCI). RESULTS ANOVA models, conducted separately for each sex, showed no significant differences, due to sample size. RCI methodology showed significant differences in the percentage of patients improved in both groups, as well as clinically relevant changes being observed individually. CONCLUSIONS The RCI method is presented as an attractive alternative as regards the classical methods of analysis that can help in the clinical decision.
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Affiliation(s)
- Mikel Montero
- DeustoPsych, I+D+i en Psicología y Salud, Facultad de Psicología y Educación, Universidad de Deusto, Bilbao, Vizcaya, España.
| | - Ioseba Iraurgi
- DeustoPsych, I+D+i en Psicología y Salud, Facultad de Psicología y Educación, Universidad de Deusto, Bilbao, Vizcaya, España
| | - Begoña Matellanes
- DeustoPsych, I+D+i en Psicología y Salud, Facultad de Psicología y Educación, Universidad de Deusto, Bilbao, Vizcaya, España
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Colson S, Gentile S, Côté J, Lagouanelle-Simeoni MC. Spécificités pédiatriques du concept d'éducation thérapeutique du patient : analyse de la littérature de 1998 à 2012. SANTÉ PUBLIQUE 2014. [DOI: 10.3917/spub.139.0283] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Korta Murua J, López-Silvarrey Varela A. [Asthma, educators and school]. An Pediatr (Barc) 2011; 74:141-4. [PMID: 21382597 DOI: 10.1016/j.anpedi.2011.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 02/02/2011] [Indexed: 11/24/2022] Open
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Cano-De La Cuerda R, Useros-Olmo AI, Muñoz-Hellín E. [Effectiveness of therapeutic education and respiratory rehabilitation programs for the patient with asthma]. Arch Bronconeumol 2010; 46:600-6. [PMID: 20846775 DOI: 10.1016/j.arbres.2010.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Revised: 06/28/2010] [Accepted: 07/13/2010] [Indexed: 10/19/2022]
Abstract
Asthma is a chronic complex and heterogeneous disease, with great variability and has a huge impact, not only on patients who suffer the disease but also their families and society in general. The education of the asthmatic patient and their families is essential for therapeutic intervention. Through continuous, dynamic and adaptive education, changes in attitudes and behaviours of the patient and family can be achieved, and will undoubtedly lead to an improvement in their quality of life. Among other non-pharmacological interventions, respiratory rehabilitation is an alternative treatment, and is primarily aimed at patients with moderate to severe asthma. Although the latest clinical practice guidelines published in the scientific literature recommend two strategies for treatment, the results of relevant publications are diverse. The objective of this study was to describe the effectiveness of therapeutic and educational programs in respiratory rehabilitation of the asthmatic patient.
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Affiliation(s)
- Roberto Cano-De La Cuerda
- Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
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