Clinical Question: Do educational programs for the self-management of asthma affect outcomes in children and adolescents?
Setting: Outpatient (any)
Study Design: Meta-analysis (randomized controlled trials)
Synopsis: A 1992 meta-analysis of self-management education for patients with asthma found no effect on children or adolescents; the analysis was based, however, on relatively few studies and may not have had enough power to show a difference if one existed.
The authors of the current meta-analysis searched several databases and identifed 32 randomized controlled trials that involved a total of 3,706 patients. The authors thoroughly searched the literature, including in their analysis articles published in any language. Their criterion for quality analysis was whether the investigators enrolling patients into the studies were unaware of the group to which the patients would be assigned (i.e., concealed allocation); only 38 percent of the studies had a thorough description of this concealed allocation to treatment group, and 10 percent did not conceal allocation. However, results were similar when the high-quality studies were analyzed separately from lower quality studies.
The educational programs were diverse and targeted children, adolescents, or both. These were not two-minute lectures on how to use a peak flow meter; most used multiple sessions and focused on symptom-based strategies. In the four studies that evaluated lung function, the educational programs were associated with a moderate beneficial effect (standardized mean difference = 0.50; 95 percent confidence interval, 0.25 to 0.75), which translated into an approximate 10 percent increase in the rate of peak expiratory flow. Absences from school, night disturbances, and the number of days with restricted activities were fewer in the children who received the education, and children with moderate to severe asthma, as expected, experienced a greater effect. Children in the educational program reported a moderate improvement in the control of their asthma. Visits to emergency departments were fewer in the educated patients, although the rates of hospitalization were not affected.
Bottom Line: Teaching children and adolescents how to manage their asthma improves their feeling of self-efficacy, improves lung function, decreases the number of days spent away from school and the number of days with restricted activity, and decreases the number of visits to the emergency department. These are formal, multiple-session programs. Teaching methods that focus on individualized responses to changes in peak flow measurements have the strongest effect. (Level of Evidence: 1a)