A study addressing the influence of knowledge and behaviour on asthma self-management concluded that while the acquisition of practical asthma knowledge is an important part of asthma self-management, it is not sufficient for a satisfactory asthma self-management behaviour.24 Similarly, another study concluded that educational programs improved knowledge but did not reduce asthma morbidity.26 What these results suggest is that measuring only knowledge will not lead to a clear understanding of how it is being applied. The judgment skills tool can contribute to overcome this gap. Asthma patients are expected to play an autonomous role in self-management. They are responsible for recognizing symptoms,adjusting medicines, avoiding triggers, and being able to communicate problems and concerns to their health care providers, among others. All
these competencies require skilful patients able to use and apply information according to the situation. Thus, they can achieve an adequate self-management that leads to positive health outcomes such as betterasthma control and improved quality of life. Results from this studyshow that the High-judgment group recurred more to the doctor when problems arise and was more compliant with the use of the control medicine. Both self-management behaviours go in line with what is expected of an appropriate self-care.16 A lack of appropriate response by patients experiencing an onset of an asthma attack (i.e. not calling emergency services) has been linked to inappropriate practical knowledge. 24 Likewise, a study conducted among African American adolescents regarding asthma self-management found that 23% of the participants never sought help from other people at the first signs of breathing problems, and only 49% reported stopping their activities when experiencing breathing problems.27 Furthermore, several studies have
reported that some of the reasons for under-using medicine are due to the misunderstanding of therapy by patients, poor knowledge on asthma medication,28 and fears and misconceptions about side-effects.29 Results from a study of asthma self-management with adolescents reported that non-compliance with the therapy was partly because patients believed that the medical regimen did not have any effect on
their symptoms, hence patients selected which aspects of the regimen to follow, departing from medical guidance.30