Nurse-led rehabilitation consultation improves asthma control in primary care

AIM: To evaluate the effectiveness of a nurse-led, structured rehabilitation consultation for adults with asthma on asthma control, health-related quality of life, and patient enablement, compared with usual nursing care. BACKGROUND: Despite effective pharmacotherapy, many adults experience poorly controlled asthma. Nurse-led rehabilitation approaches that combine education, inhaler technique training, and breathing and positioning strategies may strengthen self-management in primary care. METHODS: Two-arm, parallel-group randomised controlled trial conducted in primary care in northern Portugal (March-July 2023). Adults with physician-diagnosed asthma were randomised 1:1 to a four-week intervention (four individualised sessions; 60 min in week 1 and 45 min in weeks 2-4) or to usual care. Outcomes were assessed at baseline and 4 weeks using the Control of Allergic Rhinitis and Asthma Test (CARAT; primary outcome), the mini-Asthma Quality of Life Questionnaire (mini-AQLQ), and the modified Patient Enablement Instrument (mPEI). Analyses followed a per-protocol approach, including participants who completed baseline and follow-up assessments. Between-group comparisons and effect sizes (Cohen's d) were used. Of the 124 randomised participants, 98 completed follow-up and were included in the final analysis (intervention n = 48; control n = 50). Compared with usual care, the intervention produced greater improvement in asthma control (CARAT change 5.9 ± 1.2 vs 2.3 ± 0.7; p = 0.003; d = 0.6), quality of life (mini-AQLQ change 0.85 ± 0.23 vs 0.38 ± 0.13; p = 0.006; d = 0.5), and enablement (mPEI change 8.0 ± 3.3 vs 6.0 ± 3.5; p = 0.008; d = 0.6). No adverse events were reported. CONCLUSIONS: A brief, structured nurse-led respiratory rehabilitation consultation improved asthma control, quality of life, and enablement over 4 weeks. This model can be considered as an adjunct to routine asthma care in primary care settings.