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Communications to the Editor |

Educating Adolescents About Asthma Educating Adolescents About Asthma FREE TO VIEW

Peter G. Gibson, MB
Author and Funding Information

Affiliations: John Hunter Hospital New South Wales, Australia,  Marseille, France

Correspondence to: Peter G. Gibson, MB, John Hunter Hospital, Locked Bag 1, Hunter Region Mail Centre, New South Wales 2310, Australia; e-mail: mdpgg@mail.newcastle.edu.au



Chest. 2000;118(5):1514-1515. doi:10.1378/chest.118.5.1514
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To the Editor:

Charpin et al (January 2000)1 report on the knowledge and beliefs about asthma in adolescents in Marseille, France. In the letter, they claim this to be the first study of knowledge and beliefs about asthma in the international literature, that there were no major mistakes or misapprehensions in knowledge and beliefs about the disease, and that health education is unlikely to have a major impact on asthma management in teenagers.

I wish to take issue with each of their conclusions. We surveyed adolescents in each of the secondary schools in the Hunter region of New South Wales, Australia, and investigated their attitudes and beliefs, as well as their knowledge, about asthma.2 In this survey, we included children with and without asthma. We found that asthma knowledge was poor, especially knowledge about prevention, treatment of exercise-induced asthma, and preventive therapy. Students with asthma and their peers did hold favorable attitudes to asthma and an internal locus of control, suggesting opportunities for successful educational interventions.

The conclusion that health education is unlikely to have a major impact on asthma management is false for several reasons. A recent systemic review established that improving asthma knowledge did not necessarily lead to changes in behavior.3The reasons why asthmatics are a high-risk population is because of their asthma self-management behavior, in particular, low levels of adherence. Knowledge of asthma is only one factor that impacts on asthma self-management behavior,4 and knowledge of the condition of asthma is different than knowledge of self-management behavior. Knowledge of self-management was not evaluated in the study by Charpin et al.1

When education is directed at improving self-management behavior, that is, the need to take regular preventive medication, to detect and treat exacerbations early, to seek regular medical review, and to monitor the condition, then the benefits are profound, with reduced morbidity.5

Importantly, the way to test whether health education has a benefit in adolescents is to conduct a randomized, controlled trial. We have conducted several controlled trials of health education in adolescents using a variety of strategies.6 In each case, we found that asthma knowledge did improve; in recent work, we have established in a randomized, controlled trial that asthma self-management education, when delivered by peers, led to an improvement in quality of life (S. Shah, MB, ChB; personal communication; May 1, 2000).

Adolescents with asthma are at important stages in their lives. They are moving from a period of parental supervision of their medical care, through a period where peers have the greatest influence over their health behavior, and they need to emerge at the end of this with mature beliefs and self-management behaviors that will allow successful management of the condition. This process can be facilitated by appropriate health education.

Charpin, D, Ramadour, M, Lanteaume, A, et al (2000) Knowledge and beliefs of samples of the general population about asthma [letter].Chest117,292-294. [CrossRef]
 
Gibson, PG, Henry, RL, Vimpani, GV, et al Asthma knowledge, attitudes, and quality of life in adolescents.Arch Dis Child1995;73,321-326. [CrossRef] [PubMed]
 
Gibson PG, Wilson AJ, Coughlan J, et al. The effects of limited (information-only) asthma education on health outcomes of adults with asthma. In: Cates C, DuCharme F, Gibson PG, et al, eds. Airways module. Cochrane database of systematic reviews. Oxford, UK: Update Software, 1998; issue 4.
 
Kolbe, J, Vamos, M, Fergussen, W, et al Differential influences on asthma self-management knowledge and self-management behavior in acute severe asthma.Chest1996;110,1463-1468. [CrossRef] [PubMed]
 
Gibson PG, Wilson AJ, Coughlan J, et al. The effects of self-management asthma education and regular practitioner review in adults with asthma. In: Cates C, DuCharme F, Gibson PG, et al, eds. Airways module. Cochrane database of systematic reviews. Oxford, UK: Update Software, 1998; issue 4.
 
Gibson, PG, Shah, S, Mamoon, HA Peer-led asthma education for adolescents.J Adolesc Health1998;22,66-72. [CrossRef] [PubMed]
 

Educating Adolescents About Asthma

To the Editor:

I read the interesting correspondence by Dr. Gibson about our paper, recently published in CHEST.1We were actually unaware of the paper published in 1995.2 However, we would like to stress that the scope of both papers was completely different. Our goal was to know how asthma is considered by teenagers, in comparison with other common diseases. We were able to show that there are no major misapprenhensions of asthma, as well as of the other diseases, regarding such characteristics as severity, contagiosity, heritability, frequency, and curability. Asthmatic teenagers had opinions on asthma quite similar to those of nonasthmatic teens. We concluded that beliefs about asthma are adequate. Thus, it is unlikely that providing general information about asthma would induce a large improvement in compliance. Gibson et al2 have evaluated very specific knowledge about asthma, and they express agreement that improving knowledge does not necessarily change asthmatic patients’ behavior. Our findings do not discard the possibility of reducing morbidity due to asthma by implementing specifically tailored programs that, in our mind, go far beyond general health education.

References
Charpin, D, Ramadour, M, Lanteaume, A, et al Knowledge and beliefs of samples of the general population about asthma.Chest2000;117,292-294. [CrossRef]
 
Gibson, PG, Henry, RL, Vimpani, GV, et al Asthma knowledge, attitudes, and quality of life in adolescents.Arch Dis Child1995;73,321-326. [CrossRef] [PubMed]
 

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References

Charpin, D, Ramadour, M, Lanteaume, A, et al (2000) Knowledge and beliefs of samples of the general population about asthma [letter].Chest117,292-294. [CrossRef]
 
Gibson, PG, Henry, RL, Vimpani, GV, et al Asthma knowledge, attitudes, and quality of life in adolescents.Arch Dis Child1995;73,321-326. [CrossRef] [PubMed]
 
Gibson PG, Wilson AJ, Coughlan J, et al. The effects of limited (information-only) asthma education on health outcomes of adults with asthma. In: Cates C, DuCharme F, Gibson PG, et al, eds. Airways module. Cochrane database of systematic reviews. Oxford, UK: Update Software, 1998; issue 4.
 
Kolbe, J, Vamos, M, Fergussen, W, et al Differential influences on asthma self-management knowledge and self-management behavior in acute severe asthma.Chest1996;110,1463-1468. [CrossRef] [PubMed]
 
Gibson PG, Wilson AJ, Coughlan J, et al. The effects of self-management asthma education and regular practitioner review in adults with asthma. In: Cates C, DuCharme F, Gibson PG, et al, eds. Airways module. Cochrane database of systematic reviews. Oxford, UK: Update Software, 1998; issue 4.
 
Gibson, PG, Shah, S, Mamoon, HA Peer-led asthma education for adolescents.J Adolesc Health1998;22,66-72. [CrossRef] [PubMed]
 
Charpin, D, Ramadour, M, Lanteaume, A, et al Knowledge and beliefs of samples of the general population about asthma.Chest2000;117,292-294. [CrossRef]
 
Gibson, PG, Henry, RL, Vimpani, GV, et al Asthma knowledge, attitudes, and quality of life in adolescents.Arch Dis Child1995;73,321-326. [CrossRef] [PubMed]
 
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