***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: A prospect i ve r and omised trial was performed to evaluate the effectiveness of an asthma education programme administered by an asthma nurse specialist in an out-patient setting . Sixty asthmatic patients ( mean age 28.5 years ) were enrolled , 30 to a  usual care control group and 30 to an  education group . The education group underwent an individual education programme lasting at least one hour . The following variables were measured at baseline , one month after the education programme and at one year follow-up : asthma knowledge by MCQ ( 36 point question naire ) , inhaler technique ( 7 point scale ) , peak expiratory flow rate ( PEFR ) and symptomatology by visual analogue score ( 0 to 10 score ) . The education group 's inhaler technique and MCQ score both improved significantly at one month , from 5.4 ( 0.3 ) ( mean [ SEM ] ) to 6.5 ( 0.3 ) , p < 0.001 , and from 7.5 ( 2.4 ) to 22 ( 1.8 ) , p < 0.0001 respectively . Both of these improvements were significantly greater than in the control group , and both were maintained at one year follow-up . The symptom score improved over one year in the education group , from 5.4 ( 0.6 ) to 7.6 ( 0.5 ) , p < 0.05 , and was unchanged in the control group . There was no change in the PEFR in either group . This study shows clear objective benefits to an out-patient asthma education programme conducted by an asthma nurse specialist Self-report is a frequently-used method of assessing compliance with prescribed medications in patients with chronic illnesses . Most research ers agree , however , that self-report misrepresents patient adherence to regimen prescription . In this r and omized , controlled study evaluating inhaler medication compliance , diary data was compared to electronic monitoring in 55 adults with asthma . Subjects r and omized to the treatment group received a six-week self-management program . An electronic monitor , the MDI Chronolog , was used in this study to assess inhaler use . The MDI Chronolog records the date and time of each inhaled activation . The self-report measure used was a daily asthma diary . Subjects were asked to use their inhaled medications as usual and record the date and time they administered their medication over a one-week period . Moderate correlations ( rs=.55 , Mdnd=95.8 , Mdnc=91.6 ) were found when comparing the number of administrations calculated using the MDI Chronolog to the number of administrations reported in the subject ’s diary . When the dosing interval was examined , however , the correlation was weaker ( rs=.44 , Mdndiary=92.8 , Mdnchronolog=37.5 ) . In each case , self-reported compliance was higher than monitored adherence A prospect i ve controlled trial of home monitoring of peak expiratory flow rate ( PEFR ) was conducted to determine the usefulness of an objective measure of lung function in association with an education program and a medication self-management plan in reducing morbidity in adult patients with asthma . Thirty-five patients managed themselves , using peak flow readings as the basis for the therapeutic plan coupled with educational intervention , whereas 35 control patients  used symptoms and spirometric data for following physicians ' treatment plans . After a 6-mo study period , patients in the experimental group showed statistically significant improvements in morbidity parameters ( days lost from work , acute asthma attacks , days on antibiotic therapy , physician consultations , and emergency room admissions for asthma ) , increases in FVC , FEV1 , and FEV1/FVC , mean PEFR and mean morning PEFR , decrease in percentage of the mean PEFR amplitude , and a reduction in the use of inhaled beta-agonists , oral theophylline , and oral prednisone .  Although improvements in some of these parameters were also found in the control group , they did not reach the levels of significance obtained in the experimental group . The personal use of an objective measure of lung function in association with a medication self-management plan leads to improvement in the patient 's condition BACKGROUND --A hospital based , community service asthma education programme  for adults to improve asthma knowledge , promote compliance with medication , and reduce morbidity was evaluated . METHODS --The programme was evaluated using a r and omised experimental and control group design with repeated measurements over 12 months . A volunteer community sample of 192 respondents was recruited of whom 116 satisfied the inclusion criteria . At the 12 month follow up some data were obtained for all subjects . Intervention subjects attended four 2.5 hour education sessions at weekly intervals . An asthma knowledge question naire was administered and compliance was assessed from diary records . Morbidity was assessed retrospectively by question naire , prospect ively by diary , and objective ly by spirometry and serial peak expiratory flow rate monitoring . The adequacy of medical treatment was also assessed . Data were collected at baseline , immediately after the intervention , and at three , six , nine , and 12 months after intervention . RESULTS --Improvements occurred in knowledge and compliance in the intervention group but the impact on morbidity was modest ; this was due , at least in part , to the inadequacy of medical treatment . CONCLUSIONS --Treatment of asthma should be review ed and optimised in conjunction with self-management programmes in order to improve health outcomes Abstract Objectives To assess the feasibility and effectiveness of a general practice based , proactive system of asthma care in children . Design R and omised controlled trial with cluster sampling by general practice . Setting General practice s in the northern region of the Australian Capital Territory . Participants 174 children with moderate to severe asthma who attended 24 general practitioners . Intervention System of structured asthma care ( the 3 + visit plan ) , with participating families reminded to attend the general practitioner . Main outcome measures Process measures : rates for asthma consultations with general practitioner , written asthma plans , completion of the 3 + visit plan ; clinical measures : rates for emergency department visits for asthma , days absent from school , symptom-free days , symptoms over the past year , activity limitation over the past year , and asthma drug use over the past year ; spirometric lung function measures before and after cold air challenge . Results Intervention group children had significantly more asthma related consultations ( odds ratio for three or more asthma related consultations 3.8 ( 95 % confidence interval 1.9 to 7.6 ; P = 0.0001 ) , written asthma plans ( 2.2 ( 1.2 to 4.1 ) ; P = 0.01 ) , and completed 3 + visit plans ( 24.2 ( 5.7 to 103.2 ) ; P = 0.0001 ) than control children and a mean reduction in measurements of forced expiratory volume in one second after cold air challenge of 2.6 % ( 1.7 to 3.5 ) ; P = 0.0001 ) less than control children . The number needed to treat ( benefit ) for one additional written asthma action plan was 5 ( 3 to 41 ) children . Intervention group children had lower emergency department attendance rates for asthma ( odds ratio 0.4 ( 0.2 to 1.04 ) ; P = 0.06 ) and less speech limiting wheeze ( 0.2 ( 0.1 to 0.4 ) ; P = 0.0001 ) than control children and were more likely to use a spacer ( 2.8 ( 1.6 to 4.7 ) ; P = 0.0001 ) . No differences occurred in number of days absent from school or symptom-free day scores . Conclusions Proactive care with active recall for children with moderate to severe asthma is feasible in general practice and seems to be beneficial To assess the efficacy of self-management programs it is important to know what behavioural changes take place . This paper assesses whether including self-treatment guidelines ( action plans ) in a self-management program for adult asthmatics , leads to greater behavioural changes than a program without these guidelines . Patients were r and omised into a self-treatment group ( n=123 ) or an active control group ( n=122 ) . All subjects received self-management training .  Discussed topics included the pathophysiology of asthma , medication and side-effects , triggers , symptoms , smoking , physical exercise , and compliance . The only difference was that the self-treatment group received instructions about self-treatment of exacerbations and the control group did not . At 1 year of follow-up asthma-specific self-efficacy expectancies , outcome expectancies , and asthma-specific knowledge improved significantly in all patients . Only self-treatment group patients demonstrated favourable changes in generalised self-efficacy , social support , and self-treatment and self-management behaviour , in case of a hypothetical scenario of a slow-onset exacerbation . We conclude that our self-management program is effective in changing the behavioural variables , and including self-treatment guidelines ( action plans ) has added benefit Great emphasis is placed on educating asthmatics to use action plans to achieve better control of symptoms . The use of peak flow meters ( PFM ) has been recommended as an important part of self-management plans . We studied 92 ( 47 F ) adult patients with asthma in a primary care setting to compare the effectiveness of action plans using either peak flow monitoring or symptoms to guide self-management . Each patient was instructed in the use of the action plan in the context of a 6-mo asthma education program taught by a nurse .  Patients were already using inhaled corticosteroids or were newly prescribed corticosteroids by their family physician . Forty-four patients were r and omized to the PFM group and 48 to the symptoms group .  Spirometry , symptom scores , quality of life , medication use , and measures of health care utilization and morbidity ( emergency department visits , hospitalizations , unscheduled doctor visits , and days lost from work or school ) were recorded at baseline and throughout the study period . PC20 methacholine was measured at the first and at the final visits . There were significant improvements within groups for FEV1 , symptoms score , PC20 methacholine , and quality of life , but no between-group differences . A significant shift from higher to lower daily use of beta-agonists ( p < 0.008 for both groups ) and significant shifts to higher daily doses of inhaled steroids ( p < 0.001 ) occurred in each group . Adherence to the self-management plans was only 65 % in the PFM group and 52 % in the symptoms group . Outcomes for health care utilization were similar except for fewer patients making unscheduled doctor visits within the PFM group . Our findings show that education , regular follow-up , and an action plan are effective in improving asthma control and quality of life , but the routine use of PFM to guide interventions is not the only way to accomplish these objectives The purpose of the AIR/Kaiser-Permanente asthma project is to evaluate various approaches to the education of adults with asthma , identifying those types of patients for whom particular approaches are most cost effective . Critical self-management prac tices for adults with asthma were identified using the critical incident technique . An individualized and a group administered educational program are being developed to teach the identified critical skills , using the instructional models previously employed in AIR WISE and AIR POWER programs for children with asthma . Three hundred patients with moderate to severe asthma from Northern California Kaiser-Permanente Medical Group clinics will participate in a trial of these programs . Patients will be r and omly assigned to one of four conditions : One of two educational programs , an information/attention control , or a data -only control condition . Data will be collected on all patients for 15 months ; health care utilization data covering a two-year period will be available from medical records . Program effectiveness will be evaluated in terms of pre-post changes in the patients ' knowledge , attitudes , self-man agement practice s , medical condition , daily functioning , and utilization of services . Cost effectiveness will be evaluated , paying specific attention to the cost effectiveness of different educational approaches for different types of patients Two different patient education programmes for asthma in general practice were evaluated in a controlled trial . Knowledge , self management , and morbidity due to asthma were assessed in 339 patients by means of a question naire . One group then received a maximum education programme , a second group received a limited education programme , and a third acted as a control group .  274 patients were reassessed after one 1 year . In both the intervention groups , underst and ing of asthma was greater after the trial . Only in the maximum intervention group was a significant improvement in knowledge of asthma shown . Neither group showed any change in self-management ability or asthma morbidity that differed significantly from changes in the control group . These simple informational education programmes were ineffective when applied to a general practice population . Further studies of factors affecting attitudes , beliefs , and actions are needed to improve the advice and support given to asthma patients The purpose of this study was to evaluate the impact of a self-management program for adults with moderate to severe asthma on compliance with inhaled , prescribed , nonemergency medications ; asthma symptoms ; and airway obstruction . In this controlled experimental study , 55 subjects from a rural community were r and omized to one of two groups . Self-efficacy theory served as the framework for this study . Primary measures included the  Metered Dose Inhaler ( MDI ) Chronolog , a journal of daily asthma concerns , and a peak-flow meter to appraise airway obstruction . Secondary measures included the Asthma Self-Management Assessment Tool ( ASMAT ) and the Self-Efficacy for Asthma Management Scale ( SEAMS ) . These measures were completed pre- and post-intervention . Data analysis using descriptive and inferential statistics revealed that subjects receiving the self-management program increased compliance with inhaled medications ( U = 271 , p = .043 ) Our aim was to assess the efficacy of budesonide ( Pulmicort Turbohaler Astra ) used as part of a self-management plan in a group of patients with chronic asthma . One hundred and twenty five patients with nocturnal ast 
    Output:
    
There was no consistent evidence that written plans produced better patient outcomes than no written plan .
For some outcomes , there appeared to be an advantage of one type of plan over the other , but there was no consistency - one type of plan was not consistently more effective than another .
REVIEW ERS ' CONCLUSIONS The available trials are too small and the results too few and inconsistent to form any firm conclusions as to the contribution of written self management plans in the known beneficial effects of a comprehensive asthma care programme