The number of clinics was not significantly different between the groups. On subgroup analysis, patients were more likely to attend to see the doctor, and more clinics were cancelled by the nurse. However, over a 6-month period, this difference is of doubtful clinical significance, as this does not appear to have resulted in excess exacerbation rates.
Quality of life assessment is important to consider in addition to exacerbation rates. The AQ20 has been compared to the SGRQ and the Asthma Quality of Life Questionnaire and has been shown to be quicker to complete and show good correlation. There was no evidence of a difference between the groups. This quality of life assessment, in conjunction with the exacerbation rates between the groups, demonstrates that an appropriately trained specialist nurse can perform as well as that of the respiratory physician in a well-defined area. storehealthmall.eu
The strengths of our study include complete data for 88% of those enrolled into the trial. Of the 136 patients who completed the study, 133 patients (98%) had complete primary outcome data, so that bias due to missing responses should be negligible. For other outcomes (peak flow and quality of life measures), a larger amount of data were missing. On investigation, there is some evidence that the group of patients without responses are a younger group who had fewer exacerbations during the 6-month period compared with the rest of the study population. Therefore, this may be a source of bias in the study. The data collectors were blinded to the randomization procedure, and bias was also reduced because the data analyst was unaware of group allocation.
The effectiveness of the nurse specialist has been directly compared to that of the physician and subgroups of exacerbation type analyzed to identify minor differences between the groups. Only 154 patients were enrolled from 373 potential patients. This potentially could cause bias, especially as patients who were discharged within 24 h (presumably because of a milder attack) were less likely to be recruited to the study.
In this study, the respiratory nurse specialist had experience managing asthma in both primary and secondary care settings and regularly taught asthma management to a range of health professionals. The structure of the outpatient clinic was agreed before commencing the trial, and both the nurse and the doctor followed national and international guidelines for management and treatment. We believe the study is applicable to respiratory nurse specialists as a whole with appropriate experience and supervision.