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Exclusively nurse-led interventions for pediatric asthma: A systematic review and meta-analysis of randomized
Laicun Chen1, Yan Wang2, Bin Zhao3
1Department of Critical Care Medicine, Qinghai province women and children hospital, No.7, Gonghe South Road, Chengdong District, Xining, Qinghai Province 810000, China; Qinghai province pediatric medical research center, No.7, Gonghe South Road, Chengdong District, Xining, Qinghai Province 810000, China.
Background:
Despite advances in pediatric asthma management, suboptimal disease control persists, leading to frequent emergency department (ED) visits and hospitalizations. While nurse-led interventions show promise, existing literature remains fragmented, often mixing nurse-led approaches with multidisciplinary interventions or adult populations. The specific contribution of exclusively nurse-delivered care for pediatric asthma outcomes remains unclear, limiting evidence-based implementation of nursing interventions.
Objective:
To systematically review and meta-analyze randomized controlled trials evaluating exclusively nurse-led education and management interventions versus usual care in children and adolescents (≤18 years) with physician-diagnosed asthma.
Methods:
We searched four electronic databases from 2000-2025 for randomized controlled trials comparing exclusively nurse-led asthma interventions with usual care. Primary outcomes included lung function (FEV₁), asthma control (Childhood Asthma Control Test), and quality of life (Pediatric Asthma Quality of Life Questionnaire). Secondary outcomes encompassed healthcare utilization measures. Random-effects meta-analyses were performed using REML estimation.
Results:
Twenty-one trials involving 4742 participants were included. Nurse-led interventions showed no significant improvements in lung function (SMD 0.23, 95% CI:0.09-0.56), significantly improved asthma control (mean difference 4.20 points, 95% CI: 0.28-8.12), and did not significantly affect quality of life (MD -0.03, 95% CI:0.39-0.32). For healthcare utilization, ED visits were reduced by 32% (IRR 0.68, 95% CI: 0.49-0.93), while hospitalizations showed a non-significant 23% reduction (IRR 0.77, 95% CI: 0.48-1.25).
Conclusions:
Exclusively nurse-led pediatric asthma interventions may improve patient-reported asthma control and reduce ED utilization; however, very high heterogeneity (I² >90% for asthma control and quality of life) limits confidence in pooled estimates. Subgroup-specific findings should inform implementation rather than overall pooled effects. Further standardized trials with longer follow-up are needed.
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