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Education interventions for adults who attend the emergency room for acute asthmaTapp S, Lasserson TJ, Rowe BH
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SummaryEducation interventions for adults who attend the emergency room for acute asthmaSelf-management and education plans are widely recommended for treating chronic asthma; however, despite widespread endorsement of this intervention acute asthma continues to affect a large number of adults globally. We reviewed evidence from randomised trials that assessed an educational intervention given after presentation in the emergency setting by adults over 17 years old. Twelve trials involving 1954 people were included. The studies suggested that following the intervention there was a reduction in the frequency of admissions to hospital, but that the visits to the emergency department were not affected. Education may be an effective reinforcement strategy in reducing repeat presentations and hospital admission following emergency department attendance, but there was little evidence to suggest that it improved other indicators of chronic disease severity such as lung function and quality of life.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2009 Issue 4, Copyright © 2009 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This version first published online:
July 18. 2007 AbstractBackgroundThe use of educational and behavioural interventions in the management of chronic asthma have a strong evidence base. There may be a role for educative interventions following presentation in an emergency setting in adults. ObjectivesTo assess the effectiveness of educational interventions administered following an acute exacerbation of asthma leading to presentation in the emergency department. Search strategyWe searched the Cochrane Airways Group trials register. Study authors were contacted for additional information. Searches are current to November 2006. Selection criteriaRandomised, parallel group trials were eligible if they recruited adults (> 17 years) who had presented at an emergency department with an acute asthma exacerbation. The intervention of interest was any educational intervention (for example, written asthma management plan). Data collection and analysisTwo review authors independently assessed trial quality and extracted data. Study authors were contacted for additional information. Main resultsTwelve studies involving 1954 adults were included. Education significantly reduced admission to hospital (relative risk 0.50; 95% confidence interval 0.27 to 0.91); but did not significantly reduce the risk of re-presentation at emergency departments (ED) during follow up (relative risk 0.69; 95% confidence interval 0.40 to 1.21). The lack of statistically significant differences between asthma education and control groups in terms of peak flow, quality of life, study withdrawal and days lost were hard to interpret given the low number of studies contributing to these outcomes. One study from the early 1990s measured cost and found no difference for total costs and costs related to physician visits and admissions to hospital. If data were restricted to emergency department treatment, education led to lower costs than control. Authors' conclusionsThis review found that educational interventions applied in the emergency department reduce subsequent asthma admissions to hospital. The interventions did not significantly reduce ED re-presentations; while the trend in effect favours educational interventions, the pooled results were not statistically significant. The impact of educational intervention in this context on longer term outcomes relating to asthma morbidity is unclear. Priorities for additional research in this area include assessment of health-related quality of life, lung function assessment, exploration of the relationship between socio-economic status and asthma morbidity, and better description of the intervention assessed. |