***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: Background Asthma patients may experience acute episodic exacerbation . The guidelines recommend that written action plan should be given to asthma patients . However , no one can predict when and where acute exacerbation will happen . As people carry smart phone almost anytime and anywhere , smartphone application could be a useful tool in asthma care . We evaluated the feasibility of the ubiquitous healthcare system of asthma care using a smartphone application ( snuCare ) based on the self-management guideline or action plan . Methods Forty-four patients including fragile asthmatics were enrolled from Seoul National University Bundang Hospital between December 2011 and February 2012 . They were r and omly assigned into application user ( n = 22 ) or application nonuser group ( n = 22 ) . We evaluated user-satisfaction , and clinical parameters such as asthma control , Quality of Life Question naire for Adult Korean Asthmatics , and the adherence of patients . Results The characteristics were similar at baseline between the 2 groups except those who treated with short-term systemic steroid or increased dose of systemic steroid during previous 8 weeks ( user vs. nonuser : 31.8 % vs. 4.5 % , p = 0.020 ) . Total of 2,226 signals was generated during 8 weeks including 5 risky states . After eight weeks , the users answered that it was very easy to use the application , which was shown in highest scores in terms of satisfaction ( mean ± st and ard deviation , 4.3 ± 0.56 ) . Seventy-three percent of patients answered that the application was very useful for asthma care . User group showed improved the adherence scores ( p = 0.017 ) . One patient in application user group could avoid Emergency Department visit owing to the application while a patient in nonuser group visited Emergency Department . Conclusion The ubiquitous healthcare system using a smartphone application ( snuCare ) based on the self-management guideline or action plan could be helpful in the monitoring and the management of asthma Background : There is still debate over the benefit of self-management programmes for adults with asthma . A brief self-management programme given during a hospital admission for acute asthma was tested to determine whether it would reduce readmission . Method : A r and omised controlled trial was performed in 280 adult patients with acute asthma admitted over 29 months . Patients on the self-management programme ( SMP ) received 40–60 minutes of education supporting a written self-management plan . Control patients received st and ard care ( SC ) . Results : One month after discharge SMP patients were more likely than SC patients to report no daytime wheeze ( OR 2.6 , 95 % CI 1.5 to 5.3 ) , no night disturbance ( OR 2.0 , 95 % CI 1.2 to 3.5 ) , and no activity limitation ( OR 1.5 , 95 % CI 0.9 to 2.7 ) . Over 12 months 17 % of SMP patients were re-admitted compared with 27 % of SC patients ( OR 0.5 , 95 % CI 0.3 to 1.0 ) . Among first admission patients , OR readmission ( SMP v SC ) was 0.2 ( 95 % CI 0.1 to 0.7 ) , p<0.01 . For patients with a previous admission , OR readmission was 0.8 ( 95 % CI 0.4 to 1.6 ) , p=0.6 . SMP patients were more likely than SC patients to be prescribed inhaled steroids at discharge ( 99 % v 92 % , p=0.03 ) , oral steroids ( 98 % v 90 % , p=0.06 ) , and to have hospital follow up ( 98 % v 84 % , p<0.01 ) but adjustment for these differences did not diminish the effect of the self-management programme . Conclusions : A brief self-management programme during hospital admission reduced post discharge morbidity and readmission for adult asthma patients . The benefit of the programme may have been greater for patients admitted for the first time . The programme also had a small but significant effect on medical management at discharge BACKGROUND The " credit card " asthma self-management plan provides the adult asthmatic patient with simple guidelines for the self-management of asthma , which are based on the self- assessment of peak expiratory flow rate recordings and symptoms . OBJECTIVE The study was a trial of the clinical efficacy of the credit card plan in a high-risk group of asthmatic patients . METHODS In this " before- and -after " trial , patients discharged from the emergency department of Wellington Hospital , after treatment for severe asthma were invited to attend a series of hospital outpatient clinics at which the credit card plan was introduced . Question naires were used to compare markers of asthma morbidity , requirement for emergency medical care , and medication use during the 6-month period before and after intervention with the credit card plan . RESULTS Of the 30 patients with asthma who attended the first outpatient clinic , 26 ( 17 women and 9 men ) completed the program . In these 26 participants , there was a reduction in both morbidity and requirement for acute medical services : specifically , the proportion waking with asthma more than once a week decreased from 65 % to 23 % ( p = 0.005 ) and the proportion visiting the emergency department for treatment of severe asthma decreased from 58 % to 15 % ( p = 0.004 ) . The patients attending the clinics commented favorably on the plan , in particular on its usefulness as an educational tool for monitoring and treating their asthma . CONCLUSIONS Although the interpretation of this study is limited by the lack of a r and omized control group , the findings are consistent with other evidence that the credit card asthma self-management plan can be an effective and acceptable system for improving asthma care in a high-risk group of adult patients with asthma 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 function . Results : Asthma Control Question naire score changes differed between the study groups ( p < 0.05 ) . In the intervention group , these changes ( M = –0.45 ) in asthma control were close to clinical significance ( minimal important difference ≈0.5 ) . Both groups improved in disease-specific quality of life scores . For the intervention group , which changed the most ( p < 0.05 ) , the change exceeded the threshold for the minimal important difference ( 0.5 ) . The costs of medications increased significantly in the intervention group , where adjustments of medication were made more often than in controls . Conclusion : Disease-specific quality of life of asthma patients could be improved by adding structured information and monitoring by diary to st and ard care The effects on self management of asthma of a specially prepared book and audiocassette tape with similar contents were observed in a controlled study of 177 patients with asthma in general practice . After a run in period of six months patients were r and omly given the book , the tape , both the book and tape , or neither . Patients ' knowledge of the use of drugs , perceptions of their disability , skill in using an inhaler , consumption of drugs , consultations with their general practitioners , morbidity ( from patients ' entries on diary cards ) , and use of the educational material were measured . Knowledge about the use of drugs was significantly increased in the groups who received the material after three months and persisted after 12 months . Patients who had been given the tape or the book and tape increased their scores of knowledge of drugs more than patients given the book alone . Patients in all groups given the material considered that their disability was reduced . There were no other significant changes . Patients given both the book and the tape preferred the book . Patients with asthma can obtain useful information from such material . The paradoxical result whereby patients learnt more from the tape but preferred the book suggests that a distinction can be made between information that patients need , which may be acquired better from an audiocassette , and information that they want , which may be acquired better from a book OBJECTIVES To improve the asthma control and adherence to asthma preventer medication of older people using the Patient Asthma Concerns Tool ( PACT ) to identify and address unmet needs and patient concerns . METHODS Community dwelling adults over 55 years , living in Victoria or New South Wales were recruited into a single-blind , parallel design , r and omised-controlled trial comparing person-centred education including device technique , versus written information-only education .  Fifty-eight participants r and omised to the intervention group and 56 to the control completed participation . OUTCOME MEASURES asthma control , adherence to preventer medication , asthma related quality of life , asthma exacerbations and written action plan ownership were assessed at baseline , and 3 and 12 months post intervention . RESULTS Intervention participants experienced improvements in asthma control , adherence to asthma preventer medication , reduced exacerbations , improved quality of life and an increase in asthma action plan ownership at 3 and 12 months . CONCLUSION Asthma outcomes in older people can be significantly improved by delivering tailored education that identifies specific patient concerns and unmet needs . PRACTICAL IMPLICATION S Use of the PACT to identify patient concerns and unmet needs will assist health professionals to improve the health literacy of patients by addressing gaps in their knowledge and perceptions of asthma control Background Many studies have shown the effectiveness of self-management for patients with asthma . In particular , possession and use of a written asthma action plan provided by a doctor has shown to significantly improve patients ’ asthma control . Yet , uptake of a written asthma action plan and preventative asthma management is low in the community , especially amongst adults . Objective A Web-based personally controlled health management system ( PCHMS ) called Healthy.me will be evaluated in a 2010 CONSORT-compliant 2-group ( static websites verse PCHMS ) parallel r and omized controlled trial ( RCT ) ( allocation ratio 1:1 ) . Methods The PCHMS integrates an untethered personal health record with consumer care pathways and social forums . After eligibility assessment , a sample of 300 adult patients with moderate persistent asthma will be r and omly assigned to one of these arms . After 12 months of using either Healthy.me or information websites ( usual care arm ) , a post- study assessment will be conducted . Results The primary outcome measure is possession of or revision of an asthma action plan during the study . Secondary outcome measures include : ( 1 ) adherence to the asthma action plan , ( 2 ) rate of planned and unplanned visits to healthcare providers for asthma issues , ( 3 ) usage patterns of Healthy.me and attrition rates , ( 4 ) asthma control and asthma exacerbation scores , and ( 5 ) impact of asthma on life and competing dem and s , and days lost from work . Conclusions This RCT will provide insights into whether access to an online PCHMS will improve uptake of a written asthma action plan and preventative asthma actions . Trial Registration Trial Registration : Australian New Zeal and Clinical Trials Registry ACTRN12612000716864 ; https://www.anzctr.org.au/Trial/ Registration /Trial Review .aspx?id=362714 ( Archived by WebCite at http://www.webcitation.org/6IYBJGRnW ) 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 OBJECTIVES Despite advances in recent years , asthma morbidity and mortality have been noted to be on the increase in the past decade . The present study examined the failures and recommendations of past studies and introduced a new milieu for asthma care -- the community pharmacy . The study incorporated a care protocol with the important ingredients of asthma education on medications , triggers , self-monitoring and an asthma plan , with pharmacists taking responsibility for outcomes , assessment of a patient 's readiness to change and tailoring education to that readiness , compliance monitoring and physician consultation to achieve asthma prescribing guidelines . METHODS Thirty-three pharmacists in British Columbia , specially trained and certified in asthma care , agreed to participate in a study in which experienced 
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AUTHORS ' CONCLUSIONS Analysis of available studies was limited by variable reporting of primary and secondary outcomes ; therefore , it is difficult to draw firm conclusions related to the effectiveness of PAAPs in the management of adult asthma .
In the context of this caveat , we found no observable effect on the primary outcomes of hospital attendance with an asthma exacerbation , asthma symptom scores or adverse events .