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Educational interventions for asthma in children
F M Wolf1, J P Guevara, C M Grum
1Department of Medical Education, University of Washington School of Medicine, E-312 Health Sciences, Box 357240, Seattle, WA 98195-7240, USA. wolf@u.washington.edu
Insights
Asthma self-management education programs for children significantly improve health outcomes, including lung function and reduced school absences. These programs are recommended for routine asthma care to enhance children's well-being.
Area of Science:
- Pediatric Respiratory Medicine
- Health Outcomes Research
- Evidence-Based Practice
Background:
- Asthma self-management education programs are available for children.
- Evidence for their effectiveness in improving health outcomes is limited.
Purpose of the Study:
- To evaluate the efficacy of asthma self-management education on health outcomes in pediatric populations.
- To synthesize findings from randomized controlled trials.
Main Methods:
- Systematic review and meta-analysis of 32 randomized controlled trials involving 3706 children and adolescents (aged 2-18 years).
- Searches included Cochrane Registers and reference lists of relevant reviews.
- Data extraction and analysis assessed various educational interventions and asthma severities.
Main Results:
- Asthma education programs showed moderate improvements in airflow (SMD 0.50) and self-efficacy (SMD 0.36).
- Modest reductions were observed in school absence (SMD -0.14), restricted activity days (SMD -0.29), and emergency visits (SMD -0.21).
- Benefits were more pronounced in moderate-severe asthma and with peak flow-based strategies, with effects sustained up to 12 months.
Conclusions:
- Asthma self-management education programs effectively improve multiple health outcomes in children.
- Integration into routine care is recommended for prevention and management of asthma attacks.
- Further research is needed to compare intervention components and focus on quality of life outcomes.
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 and Cochrane Schizophrenia Group's Special Registers of Controlled Trials 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 -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 6 months, but for measures of morbidity and health care utilization, were more evident by 12 months.
Reviewer'S 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 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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