Different groups often have differing perceptions of what self-management is intended to do. Physicians who see it as an extension of their advice with patients being guided by what they, the physicians, tell them anchor one end of the spectrum. At the other end, there are those patients who believe they can totally control their asthma without any medical advice. Both approaches are inappropriate: the right mixture involves a shared relationship where patients assume the daily management of their condition. A study by Garbutt and coworkers described how pediatricians provide maintenance care for children with persistent asthma, as well as identified opportunities for improvement. Community pediatricians in St. Louis, Missouri completed a 34-item survey. They reported the percentage of patients for whom they would prescribe inhaled corticosteroids, and selected from checklists the activities and questions they would use during maintenance care visit. A total of 135 (60%) of 225 eligible pediatricians responded and reported they prescribed inhaled corticosteroids for most patients. Although most respondents used specific questions to assess the burden of asthma, including inquiring about the frequency of daytime (86%) and nighttime (83%) symptoms, fewer asked about activity limitations such as school absences (58%). Some reported using specific questions to assess medication adherence such as how often doses were missed (49%), or included collaborative activities to support daily self-management such as setting asthma care goals (60%), but fewer asked how symptoms were monitored (44%) or assessed the effect of the child's asthma on the parent and family (24%).

VALUE OF STUDY TO READER: The authors concluded that asthma management practices fall short of optimal standards. Opportunities for improvement include more comprehensive and detailed assessment of asthma control and medication adherence, collaborative goal setting, and better cooperation with parents to support effective self-management. We concur. It certainly appears as if these suggestions would increase the value of self-management by patients with pediatric asthma.

J. Garbutt et al. What constitutes maintenance asthma care? The pediatrician's perspective. Ambulatory Pediatrics, 2007;7:308-312.