Can asthma care coaching aimed at supporting self-management improve outcomes in older patients with asthma?

Using an asthma care coach—a high school or college graduate trained to identify barriers to asthma self-management and address them—improved quality of life and decreased emergency department visits over 1 year. The program, called Supporting Asthma Management Behaviors in Adults, is described at www.SAMBAforAsthma.com. (LOE = 1b)

Federman AD, O'Conor R, Mindlis I, et al. Effect of a self-management support intervention on asthma outcomes in older adults. The SAMBA study randomized clinical trial. JAMA Intern Med 2019;179(8):1113-1121.  [PMID:31180474]

Randomized controlled trial (single-blinded)

Foundation

Uncertain

Outpatient (primary care)

These investigators recruited 391 adults at least 60 years of age with uncontrolled moderate or severe asthma from 9 primary care practices, excluding patients with other pulmonary diseases or more than a 15 pack-year smoking history. The patients were randomized, allocation concealment uncertain, to remain in usual care or to receive the intervention either at home or in the office. The intervention comprised 3 elements delivered by an asthma care coach: (1) identifying barriers to asthma self-management, (2) targeted actions to address these barriers, and (3) reinforcement over time. Over 1 year, this coaching improved asthma-related quality of life, and emergency department visits occurred less often in patients who received the intervention (odds ratio = .8; 95% CI .6 - .99). Asthma control scores and inhaler technique were both improved in the intervention groups. The intervention was equally effective when provided in the office or at home.