Asthma as a Model for Chronic Disease Management Programs

Abstract

Chronic obstructive pulmonary disease (COPD) is a relatively new target for disease management programs; however, asthma has long been a focus for such programs, and can provide a template for respiratory disease management. A major difficulty when developing disease management programs in an area that has not previously been targeted is determining the outcomes that need to be monitored. In this area, experience in asthma management may provide direction for the management of other COPDs. Healthcare providers that manage patients with chronic respiratory diseases must use a variety of outcome measures to guide therapy. No single measure provides a complete picture of an individual’s perceived well-being and future risk of pulmonary decline. Therefore, clinicians must consider outcome measures that reflect both the short- and long-term morbidity associated with the disease process. These outcome measures include both objective measures of pulmonary function and quality-of-life assessments. Ideally, objective measures of pulmonary function would allow for direct determination of the rate of pulmonary decline. Inherent limitations mean that these measurements are instead used as a surrogate for disease control. The goal therefore is to reduce the impairment experienced by an individual and potentially slow the rate of decline in pulmonary function. The most commonly used measures of pulmonary function are pulmonary function tests, peak expiratory flows, and airway hyper-responsiveness. To use them effectively, clinicians must be aware of the information provided by these measures and the limitations with their use. Outcome measures related to quality of life provide information about a patient’s subjective experience and ability to function in daily life. It has been recognized that these measures are important to individuals with chronic diseases and that they provide clinicians with information about the disease process that cannot be determined using measures of pulmonary function. Such measures can be broadly grouped into healthcare utilization measures, symptom scores, and measures of activity limitation. These measures are essential components of long-term asthma management, but are subject to their own limitations. Measurements of pulmonary function and quality of life provide complementary information about respiratory disease processes. For example, asthma guidelines incorporate both types of measurements into current classification schemes to assess asthma impairment and risk of future morbidity. Further research is required to better understand the relationship between these outcome measures.