Key Words: Nurse-led care, Well-controlled, Uncontrolled Asthma
Is nurse–led asthma care as effective as that delivered by a physician in the management of asthma?
Asthma is a common, chronic disease, diagnosed in childhood and persists into adulthood. Symptoms, which may be constant or intermittent, include breathlessness, coughing, wheezing and chest tightness. Good asthma management, including symptom control, requires regular review by healthcare professionals to assess medication use, written asthma treatment plans, inhaler technique assessment and self-monitoring of symptoms.
This is a summary of a Cochrane systematic review of five randomized controlled trials (RCTs) containing 588 participants with a clinical diagnosis of asthma (defined by the study authors). Three studies contained adults and two contained children. Four studies included 434 patients with controlled or partly controlled asthma. One study included 154 patients admitted with an exacerbation of acute asthma (uncontrolled). There were no exclusions for co-morbidities. The intervention of interest was nurse-led care compared to physician-led care (traditional care). Nurse-led care could be provided by a specialised asthma nurse, nurse practitioner, physician assistant or an otherwise specifically trained nursing professional, working relatively independently from a physician for any aspect of asthma management, provided on a regular basis in primary or hospital care.
Summary of Key Evidence:
There were no statistically significant differences between nurse-led compared to physician led asthma care for frequency of exacerbations (one study), asthma severity and symptoms (one study), lung function (three studies), Quality of Life (three studies), symptom-free days (one study ), patient satisfaction (one study), use of rescue medication (two studies), absence from school/work (three studies), hospital admission (three studies), stepping down of ICS (one study). and quality of care (two studies).
There were no data for compliance with medication or referral from primary to hospital care. Comparisons could not be made for duration of consultation due to incomplete data (one study). One study reported physician additional workload due to assisting the asthma nurse with management support.
One study reported that nurse-led care costs of outpatient visits (per patient, per year) were significantly lower than physician-led asthma care, but combined results for total healthcare costs were not.
Best Practice Recommendations:
No significant difference was found between nurse-led care compared to physician-led care for patients with controlled or partially controlled asthma, but uncertainty remains with uncontrolled asthma.
Ann Dewey, PhD, MSc (Health Psychology) BSC (Hons) RGN
Ann Dewey is a senior lecturer at the School of Health Sciences & Social Work, University of Portsmouth, UK. She is a member of the Cochrane Nursing Care Field as well as a review author for the Cochrane Airways Group and Cochrane Pain, Palliative & Supportive Care Group.
A member of the Cochrane Nursing Care Field (CNCF)
Kuethe M.C., Vaessen-Verberne, A.A.P.H., Elbers R.G., & Van Aalderen W.M.C. (2013). Nurse versus physician-led care for the management of asthma. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD009296. DOI: 10.1002/14651858.CD009296.pub2. Available at: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009296.pub2/abstract