Asthma Self-Management in Women

Based on our experience conducting self-management research among women with asthma, and unpublished process data from these studies, we observe that the following elements appear to contribute to high participant engagement in these programs and successful outcomes. First, in participant feedback questionnaires from the Women Breathe Free and Women of Color and Asthma Control studies, women have singled out the importance of their relationship with their assigned telephone asthma educator as motivating them to make positive changes in their asthma self-management behaviors. The popularity of health and wellness coaching, including for chronic disease management, is rapidly growing [68]. This is a patient-centered approach that guides patients in setting their own goals for disease management and devising their own strategies for achieving them [68]. Strong interpersonal relationships are thought to enhance the coaching process and this may be especially important for women [68]. Participants have also indicated that they are able to apply the goal-setting and problem-solving skills they have learned as part of the intervention to management of other health or psychosocial issues in their lives; therefore this component seems especially critical for women with asthma who are typically managing multiple health issues as well as those of others. Finally, maximizing the flexibility of interventions is important for working-age women who typically are engaged in part- or full-time employment and also have significant responsibilities caring for others. This flexibility can come in the form of telephone-based or “mHealth” interventions that use mobile technologies such as text messaging [69], as well as internet-based or smartphone/tablet “apps” that can be completed at a pace and schedule that is convenient for the participant [70]. Such interventions could be easily tailored to address sex- and gender-specific issues in asthma management.

Future Research and Practice Directions

This review points to several promising directions for research and practice in the area of supporting women’s asthma self-management. The first is a systematic exploration of the added value of gender-tailoring asthma self-management support interventions to determine which subgroups of women benefit from which type of sex- and gender-specific information, and in which form. More research is needed on the relationship between hormone levels and changes and asthma symptoms, and how this affects women’s self-management. This includes recognition of new or worsening asthma with the use of hormone replacement therapy in menopausal and post-menopausal women, a group that is rapidly increasing in number in the US population. Another direction for research is a family-systems approach to asthma education and supporting asthma management. Asthma in one or more first-degree relatives has been shown across diverse populations to be a risk factor for asthma [71]. Women with asthma are therefore more likely to have children with asthma, and vice-versa; however, no prior research was identified that addresses asthma self-management in mother/child dyads. For example, it is possible that teaching women to better manage their own asthma could have “trickle down” effects to how they help a child manage asthma. Last, as the above discussion of factors affecting women’s asthma makes clear, many risk factors for poor asthma management and control in women cluster together, such as obesity, depression, and GERD. Interventions that attempt to address the separate and interacting effects of these factors and comorbidities, may yield better outcomes among the most vulnerable asthma patients.

Corresponding author: Mary R. Janevic, PhD, Center for Managing Chronic Disease, University of Michigan School of Public Health, 1425 Washington Heights, Ann Arbor, MI 48109, mjanevic@umich.edu.

Financial disclosures: None.