From a Tiny Seed Grows a Forest
One Respiratory Educators Perspective
Amy Reid, RRT, CRE
In 2004, Dr. Christopher Licskai (BSc, MD, FRCPC) took an idea, a small seed, and nurtured it! Dr. Licskai wondered if he could improve the lives of patients with asthma while also decreasing healthcare costs by placing trained asthma educators in the community. Between October 2004 and November 2006 a study was created using 523 asthma patients and 33 physicians in 19 sites. After an initial visit, patients would receive follow-up visits at 4 weeks, 2 months, 3 months, 6 months, and yearly based on need. During these visits the objectives for educators were: to complete spirometry, to describe the role of medication, to provide inhaler device technique teaching, and to discuss environmental control strategies. At the end of the study the results were quite impressive, showing a reduction of healthcare utilization by 58.6%.
Previous studies of the same nature had also been conducted (by the Ministry of Health and Long Term Care) with similar results. It is due to those studies and also due to the results from the coroner’s inquest, for Joshua Fleuelling, that the Ministry of Health determined that asthma education was a worthwhile endeavour and developed a fully funded program for asthma. Presently, in Essex County (Ontario) we are implementing an asthma education program with 60 physicians, 1350 patients, and 19 asthma educators (8 active).
We see patients at 4 weeks, 2 months, 3 months and 6 months as needed. Initial appointments last approximately 1 ½ hours and follow-up appointments are currently scheduled at 1 hour. Our interviews are all guided by a computer program that follows the Asthma Consensus Guidelines. Questioning includes: family history, personal medical history, symptom assessment, current medications, use of devices, environmental assessment (home, work, social), as well as discussions surrounding smoking and smoking cessation. Spirometry is also completed at each appointment. At the close of each interview a management plan is developed collaboratively between the educator and the primary care physician.
We are seeing among our patients the dramatic lack of understanding of their illness. It is astounding to learn what the definition of ‘asthma control’ is for some of them. There are those who believe that they are under control despite daily coughing and constant use of their ‘rescue’ inhaler! Clearly education is not only necessary, but imperative. We need to teach people the importance of asthma control, and how to achieve that control.
Each visit concludes with the patient receiving an individualized action plan - a tailored strategy which a patient can employ in order to help manage their asthma when it becomes out of control. Action plans have been liberating patients with asthma, creating an ability to manage their condition without the need to see a physician for every cold. As a wonderful side benefit, patients have experienced a decreased number of exacerbations! We are witnessing a dramatic first-hand improvement in the quality of life of our patients as well as a decrease in patient reliance on higher cost medical intervention. Clearly, our investment in asthma education is benefiting not only patients but reducing the pressure on our health care system.
As this program continues to grow, other programs are developing with the same intention. This past summer ARGI (Asthma Research Group INC.), piloted its first day camp for children with asthma. The program used was based on RAP...aka, ‘Roaring Adventures of Puff.” RAP is a supported program by the Lung Association and was created by The University of Alberta – Alberta Asthma Centre. The ARGI program consists of an 8 hour day filled with fun and games aimed at helping children to understand not only the pathophysiology of asthma, but also the treatments and treatment options available to them. The children also quickly develop a distinct sense of camaraderie as they quickly realize that everyone in the room has one thing in common...asthma. At the close of the day the children provided a wealth of positive feedback, and we are hopeful to continue to offer this program in the future.
Another branch from this program is lung health. ARGI hopes to develop a lung health program focused on COPD management. COPD is a leading cause of death and disability in our country. There are many people who are uninformed with regards to their condition. If we could educate them and rehabilitate them we could change lives and lessen the demand on valuable health care resources.
This is an exciting time for us in Essex County. We as Respiratory Therapists and Certified Respiratory Educators are finally being recognized and utilized for the part of our expertise which has the potential to have a dramatic impact on the lives of our patients.
In clinics we have seen children who thought that they would never again play sports, parents who regained their dreams for their children, adults who thought their breathing would never get any better! Our patients are controlling their asthma and improving their quality of life! We are enabling through education!
And so, as you can see...from one small seed, a beautiful forest is starting to take root!
 Licskai, C. (2006). Implementing asthma guidelines: A community-based, electronically supported, interdisciplinary model for asthma management in canada.
 Boulet L-P, Becker A, Bérubé D, et al. (1999). Canadian asthma consensus report 1999. CMAJ, 161 (11 Supplement), S1-S62
 McGhan S. (2006). Roaring adventures of puff: Instructor’s guide. Retrieved July 15, 2009, from the Alberta Asthma Centre Website: http://www.educationforasthma.com