***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 
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    Input: RATIONALE Although inadequate health literacy has been associated with lower asthma medication knowledge and worse metered-dose inhaler ( MDI ) technique , the relationship between health literacy and the capacity to learn asthma self-management skills is unknown . OBJECTIVES In this prospect i ve cohort study of adults hospitalized for severe asthma exacerbations at two inner-city hospitals , we examined the relationship between inadequate health literacy and difficulties learning and retaining instructions about discharge medications and appropriate MDI technique . METHODS At hospital discharge , participants received one-on-one , 30-min , guideline -based , written and oral instruction about their asthma discharge regimen as well as appropriate MDI technique . MEASUREMENTS AND MAIN RESULTS Seventy-three patients were enrolled . Inadequate health literacy was identified in 16 ( 22 % ) participants . Before instruction , inadequate health literacy was associated with lower asthma medication knowledge ( 5.2/10 vs. 7.2/10 , p < 0.001 ) and worse MDI technique ( 3.2/6 vs. 3.9/6 , p = 0.03 ) . However , inadequate health literacy was not associated with difficulty learning ( p = 0.33 ) or retaining ( p = 0.35 ) instructions about the discharge regimen . Similarly , inadequate health literacy was not associated with difficulty learning ( p = 0.26 ) or retaining ( p = 0.97 ) appropriate MDI technique . Results were similar in multivariable models adjusted for demographic characteristics and asthma severity indicators . CONCLUSIONS These findings suggest that inadequate health literacy is a surmountable barrier to learning and remembering key asthma self-management skills Patients with chronic conditions are increasingly using complementary therapies . Asthma is the most common chronic disease in the UK . Qualitative research has suggested reasons why asthma patients use complementary therapies . However , there is little reliable quantitative evidence regarding the prevalence of complementary therapy use among asthma patients and predictors of use . A postal survey of complementary therapy use among asthma patients was therefore conducted via 27 general practice s across seven Primary Care Trusts within the South West Strategic Health Authority ( Engl and ) , during August 2005 to May 2006 . A total of 14,833 asthma patients were identified . A 1-in-4 r and om sample generated 3693 potential respondents , of whom 1320 ( 36 % ) returned question naires . Taking full account of the survey design , 14.5 % ( 190/1308 ; 95 % confidence interval 12.5 % to 16.6 % ) had used complementary therapies for asthma ; 54 % of these patients had not disclosed their complementary therapy use to a health professional . The three therapies most commonly used were homeopathy , herbal medicine and relaxation . Just over half of those using complementary therapies for asthma reported that they usually or always helped ; the most common reported benefits were symptom reduction , calming breathing and reducing panic . Multivariable analyses indicated an inverted U-shaped relationship between complementary therapy use for asthma and age , and increased likelihood of use among women , those with educational qualifications , those not usually helped by asthma medication , and those who have difficulty sleeping because of asthma symptoms . Dissatisfaction with conventional care was not associated with complementary therapy use for asthma . Asthma patients may use complementary therapies with or without the knowledge of their healthcare providers . Open communication between professionals and patients about complementary therapies may be valuable to give patients enhanced opportunities to discuss the impact of asthma on their quality of life and the effectiveness of their conventional treatment High re-attendance rates are common after asthma emergency department ( ED ) care . Inadequate patient education has been cited as a potential cause of re-attendance and the optimal format of education is uncertain . The present study aim ed to compare the effectiveness of patient-centred education ( PCE ) and st and ard asthma patient education on ED re-attendance . A r and omised controlled trial was conducted at two inner-city Australian teaching hospitals ’ EDs , where patients received either st and ard patient education ( SPE ) or PCE . Both groups received a six-topic curriculum . However , PCE patients reordered the topics according to their own priority and thus controlled the order of education . In total , 146 adult patients presenting to EDs with acute asthma were enrolled . After 4 months , ED re-attendance decreased from 22 to 12 % in the PCE group and remained unchanged in the SPE group ( between group odds ratio 0.4 , 95 % confidence interval ( 0.2–1.1 ) ) . In 78 patients discharged after ED care , the PCE group had fewer re-attendances after 4 and 12 months ( 0.3 ( 0.1–0.9 ) and 0.3 ( 0.1–0.8 ) , respectively ) . PCE patients with no general practitioner care in the preceding 7 days had fewer re-attendances after 4 and 12 months ( 0.1 ( 0.0–0.7 ) and 0.2 ( 0.0–0.6 ) , respectively ) . A trend of better asthma control was evident , with a reduction in activity limitation . In conclusion , patient-centred education offers promise as a brief education process in the emergency department . However , a large multicentre trial of patient-centred education is required BACKGROUND Psychosocial factors play an important role in outcomes of asthma . Perceived control , a measure of patients ' beliefs about their ability to control their disease , has not been studied in association with asthma health outcomes METHODS We used data from a prospect i ve cohort study of patients who were hospitalized for asthma ( n = 865 ) . After hospital discharge , we conducted structured telephone interviews to obtain demographic characteristics , asthma history , and psychological variables . Interviews included administration of the  Perceived Control of Asthma Question naire ( PCAQ ) . We then prospect ively measured emergency department ( ED ) visits and hospitalizations for asthma over time , with a median follow-up time of 1.9 years RESULTS Greater perceived control was associated with better physical health status ( mean score increment per 2-point change in PCAQ score , 1.13 ; 95 % confidence interval [ CI ] , 0.79 to 1.47 ) , better asthma-related quality of life ( mean score increment , -2.24 ; 95 % CI , -2.6 to -1.83 ) , fewer days of restricted activity due to asthma ( mean increment , -1.23 ; 95 % CI , -1.62 to -0.83 ) , and lower asthma severity scores ( mean score increment , -0.40 ; 95 % CI , -0.53 to -0.27 ) . In a multivariate model , greater perceived control was associated with a significantly decreased prospect i ve risk of ED visits ( hazard ratio [ HR ] , 0.92 ; 95 % CI , 0.86 to 0.98 ; p = 0.008 ) and hospitalizations for asthma ( HR , 0.84 ; 95 % CI , 0.78 to 0.90 ; p < 0.0001 ) . There was no association found between perceived control and most aspects of preventive care or self-management CONCLUSIONS Greater perceived control is associated with improved asthma-related health status as well as with a decreased prospect i ve risk of severe asthma attacks result ing in emergency health-care utilization . This difference does not appear to be mediated by changes in preventive care or asthma self-management practice The purpose of the research was to develop , implement , and evaluate a new adult asthma self-management program with a multidisciplinary perspective . Small groups of adults met for 2 hr for 7 consecutive weekly meetings . Participants were asked to practice asthma specific behaviors ( including peak expiratory flow monitoring , avoidance/removal of asthma triggers , and controller medication adherence ) and general lifestyle behaviors ( including drinking water , practicing relaxation , washing h and s , and exercising ) . Learner-centered teaching techniques such as interactive communication and social support were utilized to help participants practice self-management behaviors including problem-solving and goal - setting . Paired sample t-tests included statistically significant improvements in asthma knowledge , asthma specific quality of life ( QOL ) , asthma specific behaviors such as peak flow monitoring and general life style behaviors such as frequency of daily exercise . These results provide evidence that this new adult asthma self-management program can lead to both knowledge acquisition and behavioral changes Background . Some asthma patients remain poorly controlled despite receiving care consistent with treatment guidelines . Objective . This study compared the ability to sleep , work , and participate in leisure activities among subjects with immunoglobulin E – mediated ( allergic ) asthma initiating omalizumab ( omalizumab start group ) with subjects receiving moderate-to-high doses of salmeterol/fluticasone combination therapy  , who continued on salmeterol/fluticasone combination therapy for at least a year without adding omalizumab ( salmeterol/fluticasone combination continuation group ) . Methods . Subjects completed an  Internet-based screener  and , if eligible , an Internet-based question naire . A propensity score model was utilized in the analysis . Group differences were assessed through logistic and linear regression models . Analyses were adjusted for propensity score quintile , how subjects heard about the study , and responses to retrospective single-item questions . Results . The analysis population included 86 omalizumab start group subjects and 436 salmeterol/fluticasone combination continuation subjects , recruited from June to November 2006 . In the adjusted analyses , the omalizumab start group was more than twice as likely to have controlled asthma as measured by the Asthma Control Test ( odds ratio , 2.62 ; p = 0.005 ) . The omalizumab start group had significantly fewer sleep disturbances as measured by the Jenkins Sleep Evaluation Question naire ( least-square means difference , −1.65;p = 0.004 ) , less activity impairment as measured by the Work Productivity Activity Impairment-Asthma Scale ( least-square means difference , −13.36;p < 0.001 ) , and less difficulty in activities as measured by the Valued Life Activities Question naire ( least-square means difference , −0.24 ; p < 0.001 ) . Conclusion . Asthma subjects who started taking omalizumab reported more improvement in asthma control , fewer sleep problems , less activity impairment , and less difficulty with activities than a similar cohort of subjects who continued taking salmeterol/fluticasone combination therapy Background Internet-based self-management has shown to improve asthma control and asthma related quality of life , but the improvements were only marginally clinical ly relevant for the group as a whole . We hypothesized that self-management guided by weekly monitoring of asthma control tailors pharmacological therapy to individual needs and improves asthma control for patients with partly controlled or uncontrolled asthma . Methods In a 1-year r and omised controlled trial involving 200 adults ( 18 - 50 years ) with mild to moderate persistent asthma we evaluated the adherence with weekly monitoring and effect on asthma control and pharmacological treatment of a self-management algorithm based on the Asthma Control Question naire ( ACQ ) . Participants were assigned either to the Internet group ( n = 101 ) that monitored asthma control weekly with the ACQ on the Internet and adjusted treatment using a self-management algorithm supervised by an asthma nurse specialist or to the usual care group ( UC ) ( n = 99 ) . We analysed 3 subgroups : patients with well controlled ( ACQ ≤ 0.75 ) , partly controlled ( 0.75>ACQ ≤ 1.5 ) or uncontrolled ( ACQ>1.5 ) asthma at baseline .  Results Overall monitoring adherence was 67 % ( 95 % CI , 60 % to 74 % ) . Improvements in ACQ score after 12 months were -0.14 ( p = 0.23 ) , -0.52 ( p < 0.001 ) and -0.82 ( p < 0.001 ) in the Internet group compared to usual care for patients with well , partly and uncontrolled asthma at baseline , respectively . Daily inhaled corticosteroid dose significantly increased in the Internet group compared to usual care in the first 3 months in patients with uncontrolled asthma ( + 278 μg , p = 0.001 ) , but not in patients with well or partly controlled asthma . After one year there were no differences in daily inhaled corticosteroid use or long-acting β2-agonists between the Internet group and usual care . Conclusions Weekly self-monitoring and subsequent treatment adjustment leads to improved asthma control in patients with partly and uncontrolled asthma at baseline and tailors asthma medication to individual patients ' needs . Trial registration Current Controlled Trials IS RCT Background : In clinical trials of asthma , the outcomes are often good , but when the same treatment regimens are implemented in primary care , equally good results are not obtained . Objective : To investigate if addition of structured patient information and monitoring by an asthma diary in primary care improves asthma control . Methods : 141 patients from 19 primary care centres were studied . The centres were r and omised to a st and ard care group or to an intervention group . The intervention group received structured written and oral information about asthma and asthma medication , and were instructed to keep an asthma diary . The primary outcome was asthma control as assessed by the Asthma Control Question naire . Secondary outcomes were costs of asthma medication , the Mini Asthma Quality of Life Question naire score and lung 
    Output:
    
Although some studies show promise regarding the benefits of patient-focused care , these methods require additional study on feasibility and strategies for implementation in real world setting s. Further , it is imperative that future studies must be , themselves , patient-centered ( eg , pragmatic comparative effectiveness studies ) and applicable to a variety of patient population s and setting s. Despite the need for further research , enough evidence exists that supports incorporating a patient-centered approach to asthma management , in order to achieve improved outcomes and patient health