Educational interventions for asthma in children

Learning self-management strategies related to asthma prevention or attack management can help improve children's lung function and feelings of self-control, as well as reduce school absences and days of restricted activity and decrease emergency room utilization. There were no differences in the risk or frequency of hospitalizations between usual care and care supplemented with self-management education. These types of more rare and serious events may be beyond the ability of education to influence. While more research is needed to make direct comparisons between different types of interventions, the limited evidence currently available suggests that in general, self-management education works well for persons with moderate-to-severe asthma as well as for those with mild-to-moderate asthma. Peak flow-based educational strategies generally show greater effects than symptom-based strategies. Beneficial effects on measures of physiological function were apparent within six months, but benefits did not become fully apparent on measures of morbidity or health care utilization until 7 to 12 months following enrolment in an educational program.

Authors' conclusions: 

Asthma self-management education programs in children improve a wide range of measures of outcome. Self-management education directed to prevention and management of attacks should be incorporated into routine asthma care. Conclusions about the relative effectiveness of the various components are limited by the lack of direct comparisons. Future trials of asthma education programs should focus on morbidity and functional status outcomes, including quality of life, and involve direct comparisons of the various components of interventions.

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Background: 

Self-management education programs have been developed for children with asthma, but it is unclear whether such programs improve outcomes.

Objectives: 

To determine the efficacy of asthma self-management education on health outcomes in children.

Search strategy: 

Systematic search of the Cochrane Airways Group's Special Register of Controlled Trials and PSYCHLIT, and hand searches of the reference lists of relevant review articles.

Selection criteria: 

Randomized and controlled clinical trials of asthma self-management education programs in children and adolescents aged 2 to 18 years.

Data collection and analysis: 

All studies were assessed independently by two reviewers. Disagreements were settled by consensus. Study authors were contacted for missing data or to verify methods. Subgroup analyses examined the impact of type and intensity of educational intervention, self-management strategy, trial type, asthma severity, adequacy of follow-up, and study quality.

Main results: 

Of 45 trials identified, 32 studies involving 3706 patients were eligible. Asthma education programs were associated with moderate improvement in measures of airflow (standardized mean difference [SMD] 0.50, 95% confidence interval [CI] 0.25 to 0.75) and self-efficacy scales (SMD 0.36, 95% CI 0.15 to 0.57). Education programs were associated with modest reductions in days of school absence (SMD -0.14, 95% CI -0.23 to -0.04), days of restricted activity (SMD -0.29, 95% CI -0.49 to -0.08), and emergency room visits (SMD -0.21, 95% CI -0.33 to -0.09). There was a reduction in nights disturbed by asthma when pooled using a fixed-effects but not a random-effects model. Effects of education were greater for most outcomes in moderate-severe, compared with mild-moderate asthma, and among studies employing peak flow versus symptom-based strategies. Effects were evident within the first six months, but for measures of morbidity and health care utilization, were more evident by 12 months.

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