Education interventions for adults who attend the emergency room for acute asthma.
BACKGROUND
The 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.


OBJECTIVE
To assess the effectiveness of educational interventions administered following an acute exacerbation of asthma leading to presentation in the emergency department.


METHODS
We searched the Cochrane Airways Group trials register. Study authors were contacted for additional information. Searches are current to November 2006.


METHODS
Randomised, 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).


METHODS
Two review authors independently assessed trial quality and extracted data. Study authors were contacted for additional information.


RESULTS
Twelve studies involving 1954 adults were included. Education significantly reduced subsequent admission to hospital (relative risk 0.50; 95% confidence interval 0.27 to 0.91); however, did not significantly reduce the risk of re-presentation at emergency departments (ED) the study 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.


CONCLUSIONS
This 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.
Tapp
S
S
Hôpital St-François-D'Assise, Centre de recherche CHUQ, 10, de l'Espinay, Local D1-724D, Quebec City, Quebec, Canada, G1L 3L5. sylvie.tapp@crsfa.ulaval.ca
Lasserson
T J
TJ
Rowe
B h
Bh
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000517:prevention & control / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006801:Humans; D010343:Patient Admission / Q000706:statistics & numerical data*; D010353:Patient Education as Topic; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012648:Self Care