Collaborative self-management strategies for patients with respiratory disease

B. Make, Rodriguez, Dunne, Mathews, Kacmarek, Hoffman, Hill, Celli, Stoller, J. R. Bach, Gilmartin, Pierson

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32 Scopus citations


The effectiveness of collaborative self-management of respiratory disorders has been most clearly demonstrated in asthma. In both adults and children with severe asthma requiring emergency care and hospitalizations, collaborative self-management can decrease not only the need for emergency care and hospitalization but also time lost from work and school, thereby increasing the patients' ability to be full and active participants in the community. Collaborative self-management is best provided in a comprehensive program that includes ready access to healthcare professionals, education, behavioral therapy, and peak-flow monitoring. The relative value of each of these components and the value of single components applied simultaneously is unclear. In some studies, asthma symptoms and medication adherence have also improved following implementation of collaborative self-management. The available data indicate that collaborative self-management should be considered as a potential therapeutic adjunct in the management of every patient with asthma and should be routinely employed with patients who have severe disease as defined by emergency room use and hospitalizations. Additional investigations should be conducted in patients with other respiratory diseases to define the role of collaborative self-management. Nonetheless, state-of-the-art medical care and the nature of the patient- physician relationship in the 1990s dictates that collaborative self- management be routinely employed in the optimal outpatient management of any individual who is interested in participating in his or her own healthcare. However, individualization of the practitioner-patient relationship is necessary. Not all patients desire to play an active role in their illness and its management. The personality, attitudes, and desires of individuals in assisting in their own management must be assessed. Theory would suggest that patients who do not appear to have an interest in self-management may have low self-efficacy that may be increased by educational efforts. Improved self-efficacy and active participation in disease management may result in beneficial outcomes. It is clear that the physician-patient relationship has changed over the past decade. As patients have been empowered to act in their own best interests, the physician's role as an educator and facilitator has become more prominent than ever. Even if medical investigations had not demonstrated any beneficial effects of collaborative self-management, patients have the right to participate in decisions affecting their healthcare and are increasingly exercising that right. Respiratory care practitioners are in a unique position to enhance collaborative self- management. In the home environment, RCPs can foster smoking cessation and serve as a liaison between patients and physicians. Education and reinforcement of collaborative self-management should be a part of every home visit performed by respiratory care practitioners, particularly in patients using CPAP, oxygen, and mechanical ventilation. In 1993 it seems unnecessary to suggest that healthcare practitioners should, as a National Institutes of Health Workshop recommended in 1989, 'encourage education as a regular part of routine asthma care.' Our patients are far ahead of this simple recommendation and are demanding more of their healthcare practitioners. We need to be prepared to institute collaborative self-management in all patients with respiratory disease.

Original languageEnglish (US)
Pages (from-to)566-583
Number of pages18
JournalRespiratory care
Issue number5
StatePublished - 1994
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine


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