Use of biological markers of airway inflammation to detect the efficacy of nurse-delivered asthma education

Objective: The purpose of this study was to determine whether analysis of the constituents of induced sputum could be used to document the efficacy of a nurse-delivered patient education intervention and whether changes in the biological markers of inflammation in sputum would correlate with improvements in pulmonary function and symptoms. Design: The study design was prospective, open trial with repeated measures. Setting: The study took place at a West Coast academic medical center laboratory. Subjects: Subjects included 12 nonsmoking persons with asthma, ages 23 to 51 years, on prescribed daily anti-inflammatory inhaled therapy who had not required oral prednisone in the previous 4 weeks of enrollment. Method: The effect of one 30-minute asthma education session on spirometry, peak flow, symptoms, and biological markers of inflammation in sputum was tested for 8 weeks to determine whether biological markers reflect the efficacy of educational interventions. Results: Mean symptom scores decreased and lung function increased slightly over 8 weeks. Markers of eosinophil degranulation decreased by 50% and albumin by 25% from baseline to 8 weeks. Eosinophil percentages dropped 20% over time but did not change consistently at all time points. Clinical markers of asthma control correlated in the low-to-moderate range with biological markers of airway inflammation. Conclusion: The results of this study show the effects of a patient education intervention can be detected in both clinical and biological outcomes. Individual education may influence self-care of asthma including adherence to inhaled corticosteroid therapy and thereby suppress airway inflammation. (Heart Lung® 2001;30:39-46.)