The Asthma Education Clinic Ltd. (AEC)

Asthma Education: Principles and Practice

Book Review
Spring 2006 Canadian Journal of Respiratory Therapy, Page 39
www.csrt.com

Asthma Education: Principles and Practice
By Ian Mitchell, MD, FRCP(C) and Gaynor Govias, B Sc, B Ed, CAI.

Mitchell and Govias who coauthored the text “Asthma Education: Principles and Practice”, have provided asthma educators with an extremely well written, thoroughly detailed guide that addresses a number of topics from both a medical as well as an educator’s perspective.

The intent of this review is to critique the applicability and relevance of this American-based text to the Canadian Asthma Educator's agenda in terms of its readability, user friendliness and case of implementation. This all-encompassing text consists of three sections, 14 chapters and is just under 500 pages in length including references and index.

The first section, (chapters 1-7), reviews the basic fundamentals of asthma including; physiology of the lung, pathophysiology of asthma, disease presentation, differential diagnosis, pulmonary function tests, triggers, medications and devices. This section also addresses “special situations” in asthma. such as pregnancy, occupational asthma and anesthesia to name but a few. The importance of recognizing comorbidities and the impact these can have on asthma control as well as a patient’s ability to learn are discussed.

In Section 2, (chapters 8-11), the strategy is to define the role of education. Its emphasis is on the importance of taking a collaborative, integrated approach between the primary care physician, asthma educator and the patient, arguing that this approach tends to he the most effective in achieving disease control. Establishing the patient’s needs must first be determined before the education process can begin.

Chapter 8 provides a virtual step-by-step pathway on how one can effectively map out the patient’s initial and follow-up visits. This can prove to be a very effective tool for those who are considering developing an asthma education program, ensuring the focal point always remains on the patient’s needs.

Adherence “...which involves much more than following a prescription for medication given by a physician” (Mitchell & Govias, pg. 268) is the scope of Chapter 9. This chapter is one of the most important and useful in the text for both new educators and for those who have been working in the field for a period of time. It is a superbly detailed review of what adherence and non-adherence is. Time is spent outlining common issues associated with each entity and providing general approaches to the adherence phenomenon.

The result of successful teaching or educating is learning. This idea is fostered by a number of principles and is the essence of Section 3. Effective asthma educators must be able to adapt and change their teaching styles based on each patient’s needs and learning styles. This section is highly condensed, reviewing numerous models and theories that are incorporated into all CNAC-approved asthma educator programs.

Overall Rating: 4 out of 5
Very Good

Who needs this text:

In light of its depth and diversity, all health care professionals involved in asthma education could benefit from this text.

Strengths

Chapters are independent of each other therefore, the book does not need to be read cover to cover; can be used as a reference guide.
Clearly outlines definitive objectives for each chapter
Case studies throughout each chapter
Chapter on “frequently asked” questions briefly addresses realistic encounters an educator may be faced with

Weaknesses

The most apparent weakness in this text is chapter 6 “Asthma Management and the Use Of Medication”. This text is American based, therefore the names and dosages of some of the medications are not the same as in Canada (i.e. Flovent 44 ug per puff , whereas in Canada it is 50 ug, Albuterol, is called Salbutamol in Canada).
Most of the governing and regulating bodies referenced are of US domain. This, in combination with the differences in dosing, could prove to be difficult to relate back to the Canadian educator.
A typing error must also be noted on page 208 in figure 7-10. It states 48 puffs of Albuterol can be given every 20 minutes for 3 doses when treating an asthma exacerbation. The reader can only assume this should read 4-8 puffs of Albuterol, not 48 puffs.

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