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


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


METHODS
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.


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


METHODS
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.


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.


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.
Wolf
F M
FM
Department of Medical Education, University of Washington School of Medicine, E-312 Health Sciences, Box 357240, Seattle, WA 98195-7240, USA. wolf@u.washington.edu
Guevara
J P
JP
Grum
C M
CM
Clark
N M
NM
Cates
C J
CJ
D000293:Adolescent; D001249:Asthma / Q000503:physiopathology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D018849:Controlled Clinical Trials as Topic; D006801:Humans; D010353:Patient Education as Topic; D015397:Program Evaluation; D016032:Randomized Controlled Trials as Topic; D012648:Self Care