Patient Education and Counseling 32 (1997) S21–S33 The asthma self-management plan system of care: What does it mean, how is it done, does it work, what models are available, what do patients want and who needs it? 1 1 2, * David Fishwick , Wendyl D’Souza , Richard Beasley Department of Medicine, Wellington School of Medicine, PO Box 7343, Wellington South, Wellington, New Zealand Keywords: Asthma; Self-management plan; Guidelines 1. Introduction models are available, what patients seem to want, which asthmatics need to follow self-manage- Recently published national and international ment strategies, and other issues relevant to guidelines have recommended that asthma self- compliance with this system of care. In addition, management plans are an essential part of the we suggest practical and simple guidelines for the long term management of adult asthmatic pa- use of self-management plans by adult asthmatic tients [1–5]. Despite this consensus view, there subjects. are significant differences in the structure and Although asthma self-management is some- detail of the specific plans that have been rec- times considered synonymous with asthma edu- ommended, the ways in which they have been cation programmes [6], this chapter focused only introduced, and the groups of asthmatic patients on aspects associated with the standardised writ- which are thought to benefit most from their use. ten self-management guidelines given to adult As a result, it is necessary to consider these patients. Whereas the centrality of asthma educa- issues before accepting and following the recom- tion to self-management is undisputed, and per- mendations made in the guidelines. haps even impossible to separate, asthma educa- This is the approach that we have taken in this tion has been covered in other chapters and will review, which concentrates on what is meant by not be specifically discussed. the term ‘‘asthma self-management’’, how self- management plans are developed and im- plemented, the evidence for their efficacy, what 2. What does it mean? The term asthma self-management is used to * Corresponding author. Tel.: 1 64 4 3855589; fax: 64 4 describe the process whereby individual asth- 3895427; e-mail: beasley@wnmeds.ac.nz 1 matic patients make changes to their treatment Senior Research Fellows. 2 Professor of Medicine. in response to the recognition of changes in the 0738-3991 / 97 / $17.00 u 1997 Elsevier Science Ireland Ltd. All rights reserved. PII S0738-3991(97)00093-1