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How to Choose an Asthma Booklet

by Thomas F. Plaut, M.D.
Advance for Physician's Assistants, Sept. 1996.

Everyone is trying to do more with less. It takes a lot of time to teach patients to manage their asthma. But education will save time and expense in the long run. Using effective materials will make your job easier. Dozens of pamphlets, videos, books and self-management programs are available. How can you identify the good ones? One approach is to use the list below which covers the basic points that patients need to know about asthma. I devised a scoring system for each of these items. This scale enables you to compare materials for completeness and accuracy.

Rating Asthma Learning Materials
The best score in each category is 10. It requires that items 3 and 6 are also present. The score is reduced to zero if there is any serious error.
Proper Expectations for Excellent Control Devices
3
  Most asthma patients will be fully active
3
  Metered-dose inhaler, holding chamber, compressor-driven nebulizer with indications
6
 Rare missed school or work 
6
  Proper instruction for two out of three
10
  No emergency visits or hospitalizations
10
  Proper instruction for all three
Signs of Asthma Trouble Aspects of Asthma Reaction
3
  Mentions cough, wheeze, retraction and increase in respiratory rate
3
 Inflammation and bronchoconstriction 
6
 Grading of signs
6
 Accurate illustration
10
 Emphasizes mild and moderate signs
10
 Hyper-reactivity
Triggers Diary
3
 Definition
3
 Tracks medicines, signs, peak flow, triggers, symptoms
6
 Mention: pollutant, allergen, viral, cold, air, exercise
6
 All five items in a single column for date
10
 Avoidance, additive effect of triggers
10
 Graphic form that is easy to analyze
Peak Flow Monitoring Home Treatment Plan
3
  Recommend home use
3
 Asthma care zones
6
 Instructions for use
6
 Presents clear example of zone management
10
 Analyze by zone
10
 Zone based on peak flow or on signs
Medicines Criteria for Choosing a Provider
3
 Presents concepts of relievers and preventers
3
 Gives printed instructions
6
 Good and bad effects of cromolyn, inhaled steroids, beta-agonists and oral steroids
6
 Demonstrates and monitors use of all devices recommended
10
 Generic and brand names
10
 Checks peak flow or PFT at each visit
Name
One Minute Asthma
Your Asthma Can Be Controlled
Asthma: Taking Control
Expectations
10
10
3
Signs
10
0
0
Triggers
10
0
6
Peak Flow
10
3
10
Medicines
6
0
10
Devices
10
0
0
Asthma Reactions
10
3
10
Diary
10
0
0
Treatment Plan
10
0
10
Choice
10
0
0
TOTAL SCORE
96
16
49
 

Using this system, I have rated a dozen pamphlets and videos. The possible scores in each category are 3, 6 and 10. A score of 10 is only possible if 3 and 6 are present. Any serious error in an item reduces the score to zero. The chart presents the scores for three pamphlets, "One Minute Asthma: What You Need to Know" (Pedipress, 1995), "Your Asthma Can Be Controlled: Expect Nothing Less" (NHLBI, 1991) and "Asthma: Taking Control for a Healthier Life" (Krames, 1994). Three columns are blank so you can rate your favorite pamphlets.

In my opinion, any educational material that claims to be comprehensive should cover these 10 points. For example, a good pamphlet will give a proper description of peak flow meters, holding chambers and compressor-driven nebulizers, including indications for use and instructive illustration. A pamphlet that is deficient will force you to spend your valuable time teaching the basics. You won't have time left to provide important individualized instructions. A helpful pamphlet is suitable for use in the waiting room, the examining room, at home and in group sessions. Single page handouts limit patients to a small set of facts. Many patients are ready to learn more about their illness. Some health professionals ask their patients to read a particular page in a pamphlet and encourage them to read further. The best pamphlets are designed to highlight important points. Their illustrations are instructive rather than decorative. In addition to rating accuracy, completeness and design, you will also want to make sure the information is appropriate for your patient population with respect to reading level and cultural sensitivity.

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