Purpose: Self-management education has received increasing emphasis in asthma care. An education program developed at UAB was successful in an earlier study, but was quite labor intensive. Accordingly, physician focus groups were used to develop a second version that would be easier to implement in community practices. The purpose of this project was to replicate the first study and to compare these two programs with a "usual care" education control. Methods: A three-group randomized design assessed the impact of the education programs on health care utilization, functional status, asthma symptoms, and respiratory illnesses. Subjects were followed for two years. All subjects were patients in UAB clinics. Results: Subjects in all groups improved over the course of the study, but the three educational procedures did not differ in their impact. Conclusions: The finding that education made no difference is inconsistent with a substantial literature. Therefore, it is important to consider alternative explanations. One such explanation might be that the study was conducted in a setting where all subjects received state-of-the-art care with an emphasis on inhaled steroids. The results of the first study also were widely disseminated at UAB, and all subjects were likely to receive substantial self-management education from their physicians. In those circumstances, outcomes were already so favorable that there may have been little room for education to have much impact. More impact might occur in other settings, especially those outside academic medical centers and other centers already involved in self-management research. Also, replication studies of self-management programs have been rare, and the results clearly indicate that all intervention studies should be replicated. Clinical Implications: Self-management education is most likely to succeed in settings where extensive education is not already provided.
