In spite of the availability and widespread use of a number of effective medications, the frequency of severe attacks of asthma bronchiale including those with fatal outcome has not decreased. One possible reason for this is the delay in therapeutic intervention of up to 30 minutes resulting either from transport time to a hospital or from the response time of mobile ambulance services. Treatment delays are also frequent co-factors for decreased well-being in non-emergency cases. Prompt initiation of countermeasures, regardless of time or place, can only be guaranteed when the patient himself is capable of carrying them out with the same expertise as his attending physician. Toward this end, a model patient-training program was investigated. The didactic goal of the training was to make the patient an expert in his chronic disease. The medical goal of the training was to improve the quality of a complex long-term therapy and with it, the patient's well-being and quality of life. The content of the training corresponded largely to that contained in a lecture series for medical students or physicians on the same subject. Style and choice of words (avoidance or explanation of medical terminology) was of course adapted to the lay-status of the patients. The following topics were treated and, as appropriate, accompanied by practical training: 1. The purpose of patient training; 2. Development of shortness of breath in asthma and bronchitis; 3. Development and course of a chronic respiratory disease; 4. Tests of pulmonary function; 5. Treatment possibilities; 6. Special triggers of bronchial asthma; 7. The severe asthma attack; 8. Living with asthma or chronic bronchitis. Training was carried out in small groups composed of a physician (always the same for a given training group) and at most 15 patients. The training was carried out on an out-patient basis, one hour per week, for 10 to 12 weeks. The sample which received training consisted of 122 patients, 58 men and 64 women, average age 51,6 +/- 17,2 years, average length of illness of 11,2 (range 1-49) years. A control group composed of 46 patients received conventional treatment but no training. Prior to and following the conclusion of training, the following physiological and psychological tests were carried out on both groups: pulmonary function, asthma-specific symptom-scale, Spielberger anxiety scale, patient diary evaluation, coping test. Results were compared with the Student t test for dependent samples. Post-treatment values of the following parameters were significantly improved in the training group but not in the control group: FEVI/-VC, Rt, frequency of asthma attacks, chronic shortness of breath, sleep disturbances, trait-anxiety (Spielberger), attitude to illness. Patient training is a useful means to increase the efficacy of therapeutic measures in the chronic forms of asthma and bronchitis and to improve the patient's subjective well-being. Through training, the active participation of the patient becomes an additional therapeutic instrument in the complex medical management of these chronic diseases.
