Asthma is the most frequently reported cause of disability in children, and the number of children afflicted with the disorder is on the rise: Between 1970 and 1984, the rate of hospitalizations for asthmatic children under 15 years of age increased by at least 145%. At the same time that more and more children are being hospitalized because of asthma, positive developments are occurring in asthma drug management. These developments should facilitate outpatient management and decrease the need for hospitalization. However, asthma remains the major diagnosis for children admitted to hospitals in the United States. This suggests that many asthmatic children do not benefit from improved medical treatment possibly because they do not comply with medication instructions. The present review explores three topics: (1) the prevalence of medication compliance in children with asthma, (2) methods of assessing compliance, and (3) strategies to increase medication compliance in children with asthma.

The paper describes the development and testing of a paper-and-pencil instrument, the Life Activities Questionnaire for Childhood Asthma, that can be applied to assess activity restriction in children with asthma. It describes how items for the instrument were selected to ensure the validity of the developed instrument. The method by which the reliability of the questionnaire was established is also discussed. The result is a valid and reliable instrument that should have wide applicability in measuring activity restriction because of childhood asthma. The developed instrument has potential use in clinical settings, research, and policy making.

Nineteen educational and self-management programs for childhood asthma were described. The programs were developed for application with a broad spectrum of patients across a number of settings. A wide variety of dependent variables were applied to evaluate the 19 programs. It was concluded that when asthma management skills were performed, children and their parents could make a contribution: (1) to preventing and managing attacks; (2) to reducing asthma-related health care costs; (3) to reducing the impact asthma had on the lives of children and their families; and (4) to accepting greater responsibility for the management of childhood asthma. These outcomes demonstrate the worth of such programs.

OBJECTIVE:The effect of experimenter expectancy was investigated on the resistance to respiratory air flow, measured as total respiratory resistance (Rt) in healthy individuals.METHOD:Each of three naive experimental assistants collected air flow resistance responses from 30 subjects who they had been told were either likely or unlikely to respond to the suggestion of breathing difficulty.RESULTS:The subjects were assigned to the two conditions at random. The subjects who were described to the experimenters as being likely to respond exhibited greater Rt increases to bronchoconstriction suggestion than did the subjects who were described as unlikely to respond.CONCLUSIONS:These findings confirmed the presence of a source of variance that has not been considered previously in suggestion studies.

BACKGROUND:We developed and evaluated a self-management program for adult asthma. In developing the program, we considered questions of format and behavior control. The format we selected included components known to be effective in educational settings. We regulated asthma management behavior through the introduction of environmental cues.METHODS:Seventy-six subjects, whose asthma was generally under medical control, were assigned randomly to either a treatment group or a waiting-list control group. Those in the treatment group were exposed to a 7-week program that incorporated proven features of providing effective training and establishing behavioral control. Subsequently, subjects in the control group received the treatment. Short-term evaluation of the treatment was made after the subjects in the experimental group were trained but before the control subjects were trained. Long-term evaluation was conducted after both groups of subjects were trained.RESULTS:Over the short term, self-management training led to fewer asthma symptoms and physician visits and improvement in asthma management skills and cognitive abilities. Over the long term, self-management training was related to lower asthma attack frequency, reduced medication use, improvement in cognitive measures, and increased use of self-management skills.CONCLUSIONS:The program improved asthma management in patients whose conditions were already under good medical control. The effects of the program were apparent a year after the conclusion of self-management training.

In 1977, Bandura1Bandura AB Self-efficacy: towards a unifying theory of behavioral change.Psychol Bull. 1977; 84: 191-215Google Scholar proposed a concept he referred to as self-efficacy. The term refers to a persons belief that he or she can execute behaviors required in a particular situation. Perceptions of one's own efficacy, as well as expectations that he or she will succeed at performing given tasks, are important factors in directing the individual's behavior. Bandura2Bandura AB Social foundations of thought and action: a social cognitive theory. Prentice-Hall, Englewood Cliffs, NJ1986Google Scholar marshaled evidence that indicates the threefold impact self-efficacy has on our lives. First, self-efficacy influences the choices we make. On the basis of our beliefs regarding our potential, we tend to engage in activities we believe we can master and avoid activities we believe we cannot master. If patients believe they can make a contribution to the management of a respiratory condition, they will make concerted efforts to do so; if they do not hold self-efficacy beliefs, they may avoid assisting in the overall management of their condition. Second, self-efficacy influences motivation. A high sense of efficacy prompts patients to expend high levels of effort in activities they undertake and to persevere in the face of obstacles. Third, perceived self-efficacy affects thinking and other cognitive processes. Patients with a high sense of efficacy devote their attention and cognitive abilities to mastering problems; patients with self doubts and limited self-efficacy ruminate about the things that could go wrong with their efforts. Three aspects of self-efficacy are relevant to the self-management of respiratory conditions, including cystic fibrosis. First, effective functioning requires patients to develop skills or competencies to help manage their condition. Ability has often been considered a fixed characteristic; consequently, a patient's treatment may be designed in accordance with the perceived ability of the individual to follow the regimen. Evidence indicates skills are not fixed, however, but evolve through their acquisition and subsequent performance. Second, patients, including those with cystic fibrosis, develop self-efficacy beliefs through four sources: (a) modeling, where they imitate the performance of others to acquire specific skills required to help treat their condition; (b) social persuasion, where people tell others they believe they can succeed at performing given tasks; (c) judgments regarding any steps they need to take to alter physiologic functions, including respiratory changes; and (d) mastery experiences, where people develop self-efficacy by mastering the skills and competencies necessary for them to become partners with their physician. Finally, self-efficacy is significant because self-efficacy beliefs are often highly correlated with a person's performance.2Bandura AB Social foundations of thought and action: a social cognitive theory. Prentice-Hall, Englewood Cliffs, NJ1986Google Scholar, 3Evans RI Albert Bandura: the man and his ideas–a dialogue. Praeger, New York1989Google Scholar This prompts the question: Can we assess perceived self-efficacy by asking people to predict their ability to perform an activity successfully? According to data gathered on a number of behaviors, the answer is yes: The assessment of self efficacy permits behavior to be predicted with impressive accuracy.2Bandura AB Social foundations of thought and action: a social cognitive theory. Prentice-Hall, Englewood Cliffs, NJ1986Google Scholar, 3Evans RI Albert Bandura: the man and his ideas–a dialogue. Praeger, New York1989Google Scholar The accurate measurement of self-efficacy beliefs requires that instruments and procedures be tailored to assess specific sets of skills needed to manage given problems. In this issue of Chest (see page 1524), Bartholomew et al report on the development and evaluation of a measure of self-efficacy expectations relevant to the self-management of cystic fibrosis. They incorporated features that permit self-efficacy to be assessed in a chronic disease with multiple symptoms in which patients must learn and perform complex self-care skills over prolonged periods of time. Through use of the instrument, investigators may be able not only to predict whether patients will perform the critical skills they have been taught for managing cystic fibrosis, but also to delineate whether failures in patient performance are due to the instruction provided them or to their lack of self-efficacy and confidence regarding their ability to perform these skills and competencies.

The Knowledge, Attitude, and Self-Efficacy Asthma Questionnaire (KASE-AQ) is a paper-and-pencil instrument that was developed to allow physicians, behavioral scientists, and other health care personnel to assess asthma patients' knowledge regarding asthma, their attitudes about their asthma (including their willingness to cooperate with the physician in managing asthma), and their self-efficacy regarding their perceived ability to control the disorder. The KASE-AQ assesses changes in these patient variables following a particular intervention. The KASE-AQ proved to be reliable and internally consistent, and a factor analysis revealed presence of three subscales in the questionnaire (knowledge, attitude, and self-efficacy about asthma). Following asthma education and self-management training, experimental group subjects showed significant improvements in knowledge, attitude, and self-efficacy. Waiting-list control subjects showed similar improvements following training. Both groups' scores at 3-month follow-up remained significantly higher than their baseline scores on all 3 variables.

The development, testing, and applicability of an instrument, the Life Activities Questionnaire for Adult Asthma is described that can be used to assess activity restriction in adults with asthma. It explains how items for the instrument were selected to insure the validity of the developed instrument. The reliability of the questionnaire is also discussed. The result is a valid and reliable paper-and-pencil instrument that should have wide applicability as a component of quality of life measurement. This instrument has potential for functional use in clinical settings, research environments, and policy-making procedures.

The past two decades witnessed the proliferation of a number and variety of self-management programs for asthma, particularly for children and their families. Although there are methodologic weaknesses to many of these first-generation programs, it has been shown that the training of patients and their subsequent performance of self-management skills change morbidity indices of asthma in a significant and positive manner. The purpose of the present article is to describe directions a second-generation model of asthma self-management might take in the future. In particular, the article describes second-generation programs from three perspectives: designs of studies, dimensions of behavioral analysis, and assessment. Specific components of the model will improve future self-management programs and, in turn, enhance their value in allowing patients to become partners with their physicians in the control of asthma.

(1991). Individualized Asthma Self-Management: A Beginning. Journal of Asthma: Vol. 28, No. 4, pp. 287-289.

Many individuals with COPD develop a lack of confidence regarding their ability to avoid breathing difficulty while participating in certain activities, however minimal the physical demands of the activity may be. This lack of confidence may be expressed as low self-efficacy. As a result of low self-efficacy, COPD patients may refrain from many routine activities of daily living. Identifying situations in which individuals with COPD experience low self-efficacy would allow the development of specific treatment interventions designed to increase the patient's self-efficacy in those situations and consequently increase activity. We developed a 34-item COPD Self-Efficacy Scale (CSES) to assess self-efficacy in individuals afflicted with COPD. The CSES has good test-retest reliability (r = .77), excellent internal consistency (Cronbach's alpha = .95), and a five-factor structure (negative affect, intense emotional arousal, physical exertion, weather/environmental, and behavioral risk factors.

The aim of this study was to examine the level of anxiety in parents of asthmatic children in comparison to parents of healthy children, that is, children who did not have any chronic disease. Parental anxiety was measured using the Spielberger State-Trait Anxiety Inventory. The questionnaire was completed by 50 parents of asthmatic children and by 30 parents of healthy children. The parents of the healthy children served as the comparison group. Two parameters of anxiety were assessed by the State-Trait Anxiety Inventory: state anxiety and trait anxiety. The parents of the asthmatic children scored higher on both scales of anxiety than parents of the healthy children (44.32 vs 34.63 and 42.46 vs 34.70, respectively). No correlation was found between parental anxiety and the severity of the children's asthma.

The scientific merit of 19 educational and self-management programs for childhood asthma was assessed by comparing each program against 12 criteria. These established criteria have evolved over several decades of research with respect both to asthma and to the relationship of the disorder to behavioral and psychological factors. The results of the comparison indicated a majority of the 19 programs failed to satisfy a number of specific criteria ranging from failure to confirm the diagnosis of asthma to failure to apply acceptable standards for evaluating treatment effects. It was noted, however, that four programs satisfied at least 6 of the 12 criteria, and that five programs satisfied from 9 to 12 of the criteria. These studies, it was concluded, provide models for future research.

We examined short latency total respiratory responses during anticipation of difficult breathing in asthmatic and healthy children. Respiratory resistance was measured with the forced oscillation technique and determined independently at each of several oscillation frequencies. Regardless of the oscillation frequency at which determined, the responses of children from the two populations during anticipation were similar. Oscillation frequency, however, was important both in differentiating asthmatic from healthy children and in discriminating changes in respiratory resistance during anticipation: the higher the oscillation frequency, the less the difference between children in the two groups and the less the amplitude of the response during anticipation. Total respiratory resistance was not related to subjective estimates of airway obstruction.

A psychometric evaluation was performed on the two versions ofthe Theophylline Side Effects Scale (TSES). These instruments are designed to assess the cognitive, physiologic, and emotional side effects believed to be associated with this medication. Both parent and child forms of the TSES demonstrated excellent retest and interrater reliabilities, as well as high internal consistency estimates. The construction and research conducted with the TSES suggest that it has applications in both research and clinical settings.