Article type
Year
Abstract
Background: Previous Cochrane reviews have shown asthma self-management educational interventions for children [1] and regular medical review with peak expiratory flow monitoring and written action plan for adults [2] to bring about positive change in selective outcomes when compared with usual care.
Objectives: To determine the effectiveness in adults of asthma self-management (prevention and attack management planning) education programs on health outcomes.
Methods: We searched the Cochrane Airways Group trials register, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PychINFO, and reference lists of articles.
Randomized and controlled clinical trials comparing self-management education programs versus usual care for asthma in adults. Main outcome measures included pulmonary function tests, days of restricted activity, nights disturbed by asthma, physician visits, emergency department visits, and hospitalizations.
Two reviewers independently coded type (individual or group) and intensity (number of sessions) of educational intervention, self-management strategy (symptom- or peak flow-based), degree of asthma severity, length of follow-up, and study quality, including adequacy of allocation concealment, withdrawal rates, and type of trial (RCT vs. CCT). Study authors were contacted for additional information.
Results: Twenty-two trials involving 3304 patients were included. Asthma education programs were associated with a) improvements in measures of lung function for both FEV1 (standardized mean difference [SMD] 0.48, 95% confidence interval [CI] 0.67 to 0.30) and Peak Expiratory Flow Rate (SMD 0.47, 95% CI 0.67 to 0.27) and b) reduction in the number of both physician (SMD 0.18, 95% CI 0.29 to -0.06) and emergency department visits (SMD 0.37, 95% CI 0.54 to 0.20), but not hospitalizations. Results were variable for measures of morbidity. There was a reduction in the proportion of patients experiencing exacerbations (odds ratio [OR] 0.41, 95% CI 0.23 to 0.73) and in the number of nights disturbed by asthma (SMD 0.38, 95% CI 0.57 to 0.19). There was also a reduction in the days of restricted activity (SMD 0.30, 95% CI 0.43 to 0.16) when pooled by the fixed-effects model but not by the random-effects model. Both individual and group educational interventions were effective. There is not enough evidence to reliably discern differences based on asthma severity, number of educational sessions, type of intervention or self-management strategy. In general, less well designed studies exhibited larger effects.
Conclusions: Results of this review suggest the desirability of incorporating self-management education into routine asthma care for adults. Because self-management education combined with usual care is shown to be more effective than usual care alone, future primary studies should directly test alternative self-management interventions against one another rather than against no education controls.
Acknowledgments: Supported by National Institutes of Health Grants F06 TW02123 from Fogarty International Center and K07 HL03046 from National Heart, Lung, and Blood Institute.
References: 1. Guevara JP, Wolf FM, Grum CM, Clark NM. Effects of asthma self management educational interventions in children and adolescents: a systematic review and meta-analysis. BMJ. 2003;326: 1308-1309. 2. Gibson PG, Powell H, Coughlan J, Wilson AJ, Abramson M, Haywood P, Bauman A, Hensley MJ, Walters EH. Self-management education and regular practitioner review for adults with asthma (Cochrane Review). In: The Cochrane Library, Issue 2, 2004. Chichester, UK: John Wiley & Sons, Ltd.
Objectives: To determine the effectiveness in adults of asthma self-management (prevention and attack management planning) education programs on health outcomes.
Methods: We searched the Cochrane Airways Group trials register, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PychINFO, and reference lists of articles.
Randomized and controlled clinical trials comparing self-management education programs versus usual care for asthma in adults. Main outcome measures included pulmonary function tests, days of restricted activity, nights disturbed by asthma, physician visits, emergency department visits, and hospitalizations.
Two reviewers independently coded type (individual or group) and intensity (number of sessions) of educational intervention, self-management strategy (symptom- or peak flow-based), degree of asthma severity, length of follow-up, and study quality, including adequacy of allocation concealment, withdrawal rates, and type of trial (RCT vs. CCT). Study authors were contacted for additional information.
Results: Twenty-two trials involving 3304 patients were included. Asthma education programs were associated with a) improvements in measures of lung function for both FEV1 (standardized mean difference [SMD] 0.48, 95% confidence interval [CI] 0.67 to 0.30) and Peak Expiratory Flow Rate (SMD 0.47, 95% CI 0.67 to 0.27) and b) reduction in the number of both physician (SMD 0.18, 95% CI 0.29 to -0.06) and emergency department visits (SMD 0.37, 95% CI 0.54 to 0.20), but not hospitalizations. Results were variable for measures of morbidity. There was a reduction in the proportion of patients experiencing exacerbations (odds ratio [OR] 0.41, 95% CI 0.23 to 0.73) and in the number of nights disturbed by asthma (SMD 0.38, 95% CI 0.57 to 0.19). There was also a reduction in the days of restricted activity (SMD 0.30, 95% CI 0.43 to 0.16) when pooled by the fixed-effects model but not by the random-effects model. Both individual and group educational interventions were effective. There is not enough evidence to reliably discern differences based on asthma severity, number of educational sessions, type of intervention or self-management strategy. In general, less well designed studies exhibited larger effects.
Conclusions: Results of this review suggest the desirability of incorporating self-management education into routine asthma care for adults. Because self-management education combined with usual care is shown to be more effective than usual care alone, future primary studies should directly test alternative self-management interventions against one another rather than against no education controls.
Acknowledgments: Supported by National Institutes of Health Grants F06 TW02123 from Fogarty International Center and K07 HL03046 from National Heart, Lung, and Blood Institute.
References: 1. Guevara JP, Wolf FM, Grum CM, Clark NM. Effects of asthma self management educational interventions in children and adolescents: a systematic review and meta-analysis. BMJ. 2003;326: 1308-1309. 2. Gibson PG, Powell H, Coughlan J, Wilson AJ, Abramson M, Haywood P, Bauman A, Hensley MJ, Walters EH. Self-management education and regular practitioner review for adults with asthma (Cochrane Review). In: The Cochrane Library, Issue 2, 2004. Chichester, UK: John Wiley & Sons, Ltd.