Pharmacy World & Science

, Volume 32, Issue 6, pp 721–729 | Cite as

Clinical pharmacist counseling improves outcomes for Taiwanese asthma patients

  • Kwua-Yun Wang
  • Chih-Feng Chian
  • Hsiang-Ru Lai
  • Yen-Huei Tarn
  • Chin-Pyng WuEmail author


Objective To assess the impact of an asthma educational program provided by a nurse combined with asthma counseling provided by a pharmacist on asthma knowledge, quality of life and clinical outcomes in Taiwanese patients with asthma. Setting All patients were recruited from Pulmonary Medicine outpatient clinic, the Tri-Service General Hospital, Taipei, Taiwan. Asthma education was given in three one-hour sessions offered during monthly clinic visits. Method A total of 91 asthma patients were randomly assigned to a nurse-administered education program (Group 1), the education program with additional pharmacist counseling (Group 2), or a control group receiving routine care only (control). Three questionnaires were used for assessment at months 0, 3 and 6. Outcomes were compared between groups to determine efficacy. Main Outcome Measure Asthma knowledge, health-related quality of life, and medication adherence were measured at baseline and 3 and 6 months after enrollment. Results A total of 104 patients were enrolled; 91 completed the study. Knowledge scores of patients in Groups 1 and 2 increased significantly compared to control group. Both intervention groups showed significant increases in knowledge scores with longer follow-up. Group 2 showed a significant improvement in clinical symptoms between baseline (month 0) and month 6 (4.99 vs. 4.21, P = 0.008). No significant differences in medication adherence were seen among groups. Conclusion Regular nurse-administered asthma education with additional pharmacist counseling improves asthma knowledge and clinical symptoms in asthma patients.


Asthma Clinical outcomes Medication adherence Patient education Pharmacists Taiwan 



The authors thank the patients who participated in the project and collected these data.



Conflicts of Interest



  1. 1.
    Global Strategy for Asthma Management and Prevention. Global Initiative for Asthma (GINA) (2008). Accessed May 8, 2010.
  2. 2.
    Taiwan Department of Health, Executive Yuan. Health and vital statistics (2007). Accessed May 8, 2010.
  3. 3.
    Garg VK, Bidani R, Rich EP, Hershey E, Hershey CO. Asthma patients’ knowledge, perception, and adherence to the asthma guidelines. J Asthma. 2005;42(8):633–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Scherer YK, Bruce S. Knowledge, attitudes, and self-efficacy and compliance with medical regimen, number of emergency department visits and hospitalizations in adults with asthma. Heart Lung. 2001;30(4):250–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Bateman ED, Hurd SS, Barnes PJ, Bousquet J, Drazen JM, FitzGerald M, et al. Global strategy for asthma management and prevention: GINA executive summary. Eur Respir J 2008;31(1):143–78. Google Scholar
  6. 6.
    Bender BG, Rand C. Medication non-adherence and asthma treatment cost. Curr Opin Allergy Clin Immunol. 2004;4(3):191–5.CrossRefPubMedGoogle Scholar
  7. 7.
    Bender BG, Bender SE. Patient-identified barriers to asthma treatment adherence: responses to interviews, focus groups, and questionnaires. Immunol Allergy Clin North Am. 2005;25(1):107–30.CrossRefPubMedGoogle Scholar
  8. 8.
    Ayala GX, Yeatts K, Carpenter DM. Factors associated with asthma management self-efficacy among 7th and 8th grade students. J Pediatr Psychol. 2009;34(8):862–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Calfee CS, Katz PP, Yelin EH, Iribarren C, Eisner MD. The influence of perceived control of asthma on health outcomes. Chest. 2006;130(5);1312–8. Google Scholar
  10. 10.
    Smith JR, Mugford M, Holland R, Candy B, Noble MJ, Harrison BD, et al. A systematic review to examine the impact of psycho-educational interventions on health outcomes and costs in adults and children with difficult asthma. Health Technol Assess. 2005;9(23):iii–iv, 1–167.
  11. 11.
    Buist AS, Vollmer WM, Wilson SR, Frazier EA, Hayward AD. A randomized clinical trial of peak flow versus symptom monitoring in older adults with asthma. Am J Respir Crit Care Med. 2006;174(10):1077–87. Google Scholar
  12. 12.
    FitzGerald JM, Gibson PG. Asthma exacerbations 4: Prevention. Thorax. 2006;61(11):992–9.
  13. 13.
    Mayo PH, Weinberg BJ, Kramer B, Richman J, Seibert-Choi OS, Rosen MJ. Results of a program to improve the process of inpatient care of adult asthmatics. Chest. 1996;110(1):48–52. Google Scholar
  14. 14.
    Bailey WC, Richards JM Jr, Brooks CM, Soong SJ, Windsor RA, Manzella BA. A randomized trial to improve self-management practices of adults with asthma. Arch Intern Med. 1990;150(8):1664–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Levy ML, Robb M, Allen J, Doherty C, Bland JM, Winter RJ. A randomized controlled evaluation of specialist nurse education following accident and emergency department attendance for acute asthma. Respir Med. 2000;94(9):900–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Barthwal MS, Katoch CDS, Marwah V. Impact of optimal asthma education programme on asthma morbidity, inhalation technique and asthma knowledge. J Assn Phys India. 2009;57(1):574–9.Google Scholar
  17. 17.
    Walker J, Winkelstein M, Land C, Lewis-Boyer L, Quartey R, Pham L, et al. Factors that influence quality of life in rural children with asthma and their parents. J Pediatr Health Care. 2008;22(6):343–50.
  18. 18.
    Powell H, Gibson PG. Options for self-management education for adults with asthma. Cochrane Database Syst Rev. 2002; Issue 3. Art. No.: CD004107. doi: 10.1002/14651858.
  19. 19.
    Gibson PG, Powell H. Written action plans for asthma: an evidence-based review of the key components. Thorax. 2004;59(2):94–9. Google Scholar
  20. 20.
    Diamond SA, Chapman KR. The impact of a nationally coordinated pharmacy-based asthma education intervention. Can Respir J. 2001;8(4):261–5.
  21. 21.
    Narhi U, Airaksinen M, Tanskanen P, Enlund H. The effects of a pharmacy-based intervention on the knowledge and attitudes of asthma patients. Patient Educ Couns. 2001;43(2):171–7.CrossRefPubMedGoogle Scholar
  22. 22.
    Juniper EF, Guyatt GH, Epstein RS, Ferrie PJ, Jaeschke R, Hiller TK. Evaluation of impairment of health related quality of life in asthma: development of a questionnaire for use in clinical trials. Thorax. 1992;47(2):76–83.
  23. 23.
    Allen RM, Jones MP. The reliability and validity of an asthma knowledge questionnaire used in the evaluation of a group asthma education self-management program for adults with asthma. J Asthma. 1998;35(7):537–45.CrossRefPubMedGoogle Scholar
  24. 24.
    Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67–74.CrossRefPubMedGoogle Scholar
  25. 25.
    Nogueira KT, Silva JR, Lopes CS. Quality of life of asthmatic adolescents: assessment of asthma severity, comorbidity, and life style. J Pediatr (Rio J). 2009;85(6):523–30.
  26. 26.
    Juniper EF, Buist AS, Cox FM, Ferrie PJ, King DR. Validation of a standardized version of the Asthma Quality of Life Questionnaire. Chest. 1999;115(5):1265–70.
  27. 27.
    Abruz S, Gamble J, Heaney L. Assessment of impairment in health-related quality of life in patients with difficult asthma: Psychometric performance of the Asthma Quality of Life Questionnaire. Respirology. 2007;12(2):227–33.CrossRefGoogle Scholar
  28. 28.
    Yang ML, Chiang CH, Yao G, Wang KY. Effect of medical education on quality of life in adult asthmatic patients. J Formos Med Assoc. 2003;102(11):768–74.PubMedGoogle Scholar
  29. 29.
    Nathan RA, Sorkness CA, Kosinski M, Schatz M, Li JR, Marcus P, et al. Development of the Asthma Control Test: a survey for assessing asthma control. J Allergy Clin Immunol. 2004;113(1):59–65.CrossRefPubMedGoogle Scholar
  30. 30.
    Juniper EF, Guyatt GH, Ferrie PJ, Griffith LE. Measuring quality of life in asthma. Am Rev Respir Dis. 1993;147(4):832–4.PubMedGoogle Scholar
  31. 31.
    Rutten-van Mölken MP, Custers F, van Doorslaer EK, Jansen CC, Heurman L, Maesen FP, et al. Comparison of performance of four instruments in evaluating the effects of salmeterol on asthma quality of life. Eur Respir J. 1995;8(6):888–98.
  32. 32.
    Rowe BH, Oxman AD. Performance of an asthma quality of life questionnaire in an outpatient setting. Am Rev Respir Dis. 1993;148(3):675–81.PubMedGoogle Scholar
  33. 33.
    Leidy NK, Coughlin C. Psychometric performance of the Asthma Quality of Life Questionnaire in a US sample. Qual Life Res. 1998;7(2):127–34.CrossRefPubMedGoogle Scholar
  34. 34.
    Sanjuas C, Alonso J, Sanchis J, Casan P, Broquetas JM, Ferrie PJ, et al. The quality of life questionnaire with asthma patients: the Spanish version of the asthma quality of life questionnaire. Arch Bronconeumol. 1995;31(5):219–26.PubMedGoogle Scholar
  35. 35.
    Apter AJ, Reisine ST, Affleck G, Barrows E, ZuWallack RL. The influence of demographic and socioeconomic factors on health-related quality of life in asthma. J Allergy Clin Immunol. 1999;103(1 Pt. 1):72–8.CrossRefPubMedGoogle Scholar
  36. 36.
    Nathan JA, Pearce L, Field C, Dotesio-Eyres N, Sharples LD, Cafferty F, Laroche CM. A randomized controlled trial of follow-up of patients discharged from the hospital following acute asthma: best performed by specialist nurse or doctor? Chest. 2006;130(1):51–7.
  37. 37.
    Petkova VB. Pharmaceutical care for asthma patients: a community pharmacy-based pilot project. Allergy Asthma Proc. 2008;29(1):55–61.CrossRefPubMedGoogle Scholar
  38. 38.
    Kritikos V, Saini B, Bosnic-Anticevich SZ, Krass I, Shah S, Taylor S, et al. Innovative asthma health promotion by rural community pharmacists: a feasibility study. Health Promot J. 2005;16(1):69–73.Google Scholar
  39. 39.
    Saini B, Krass I, Armour C. Development, implementation and evaluation of a community pharmacy based asthma care model. Ann Pharmacother. 2004;38(11):1954–60.CrossRefPubMedGoogle Scholar
  40. 40.
    Saini B, Smith L, Armour C, Krass I. Instructional design and assessment: an educational intervention to train community pharmacists in providing specialized asthma care. Am J Pharm Edu. 2006;70(5):S1–S10. Google Scholar
  41. 41.
    Smith L, Bosnic-Anticevich SZ, Mitchell B, Saini B, Krass I, Armour C. Treating asthma with a self-management model of illness behaviour in an Australian community pharmacy setting. Soc Sci Med. 2007;64(7):1501–11.CrossRefPubMedGoogle Scholar
  42. 42.
    Gordois A, Armour C, Bosnic-Anticevich S, Brillant M, Burton D, Emmerton L, et al. Cost effectiveness of a pharmacy asthma care program in Australia. Dis Manag Health Outcomes. 2007;15(6):387–96.CrossRefGoogle Scholar
  43. 43.
    Saini B, Filipovska J, Bosnic-Anticevich S, Taylor S, Krass I, Armour C. An evaluation of a community pharmacy based rural asthma management service. Aus J of Rural Health. 2008;16(2):100–8.CrossRefGoogle Scholar
  44. 44.
    Mehuys E, Van Bortel L, De Bolle L, Van Tongelen I, Annemans L, Remon JP, et al. Effectiveness of pharmacist intervention for asthma control improvement. Eur Respir J. 2008;31(4):790–9. Google Scholar
  45. 45.
    Dolovich L, Sabharwal M, Agro K, Foster G, Lee A, McCarthy L, et al. The effect of pharmacist education on asthma treatment plans for simulated patients. Pharm World Sci. 2007;29(3):228–39.CrossRefPubMedGoogle Scholar
  46. 46.
    Laufenberg-Horstmann E, DeVore E, Bassuener K. The Coulee Region Community Pharmacy Asthma Intervention study. Journal of the American Pharmacists Association: JAPhA. 2006;46(6):738–46.CrossRefPubMedGoogle Scholar
  47. 47.
    Barbanel D, Eldridge S, Griffiths C. Can a self-management programme delivered by a community pharmacist improve asthma control? A randomised trial. Thorax. 2003;58(10):851–4.
  48. 48.
    McLean W, Gillis J, Waller R. The BC Community Pharmacy Asthma Study: a study of clinical, economic and holistic outcomes influenced by an asthma care protocol provided by specially trained community pharmacists in British Columbia. Can Respir J. 2003;10(4):195–202.
  49. 49.
    Weinberger M, Murray MD, Marrero DG, Brewer N, Lykens M, Harris LE, et al. Effectiveness of pharmacist care for patients with reactive airways disease: a randomized controlled trial. JAMA. 2002;288(13):1594–602. Google Scholar
  50. 50.
    Armour C, Bosnic-Anticevich S, Brillant M, Burton D, Emmerton L, Krass I, et al. Pharmacy Asthma Care Program (PACP) improves outcomes for patients in the community. Thorax. 2007;62(6):496–502.CrossRefPubMedGoogle Scholar
  51. 51.
    Bahadori K, Doyle-Waters MM, Marra C, Lynd L, Alasaly K, Swiston J, FitzGerald JM. Economic burden of asthma: a systematic review. BMC Pulm Med [serial on the Internet]. 2009;9:24+[16 pages].
  52. 52.
    Accordini S, Bugiani M, Arossa W, Gerzeli S, Marinoni A, Olivieri M, et al. Poor control increases the economic cost of asthma. A multicentre population-based study. Int Arch Allergy Immunol. 2006;141(2):189–98.CrossRefPubMedGoogle Scholar
  53. 53.
    Briggs AH, Bousquet J, Wallace MV, Busse WW, Clark TJ, Pedersen SE, et al. Cost-effectiveness of asthma control: an economic appraisal of the GOAL study. Allergy. 2006;61(5):531–6.CrossRefPubMedGoogle Scholar
  54. 54.
    Kheir NM, Emmerton L, Shaw JP. Assessing the responsiveness of the Asthma Quality of Life Questionnaire with pharmaceutical care. Pharm World Sci. 2008 Aug;30(4):322–8.

Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  • Kwua-Yun Wang
    • 1
    • 2
  • Chih-Feng Chian
    • 3
  • Hsiang-Ru Lai
    • 4
  • Yen-Huei Tarn
    • 5
  • Chin-Pyng Wu
    • 6
    • 7
    Email author
  1. 1.Nursing DepartmentTaipei Veterans General HospitalTaipeiTaiwan, ROC
  2. 2.School of NursingNational Defense Medical CenterTaipeiTaiwan, ROC
  3. 3.Pulmonary Division, Department of Internal Medicine, Tri-Service General HospitalNational Defense Medical CenterTaipeiTaiwan, ROC
  4. 4.Department of Health Promotion and Health EducationNational Taiwan Normal UniversityTaipeiTaiwan, ROC
  5. 5.Center for Pharmaceutical Care DevelopmentTaiwan Pharmacist AssociationTaipeiTaiwan, ROC
  6. 6.Landseed HospitalTaoyuanTaiwan, ROC
  7. 7.School of MedicineNational Defense Medical CenterTaipeiTaiwan, ROC

Personalised recommendations