Guevara JP, Wolf FM, Grum CM, Clark NM. BMJ. 2003;326:1038–1043
Purpose of the Study.
To determine the effectiveness of educational programs for the self-management of asthma among children and adolescents.
Eligible studies were published, randomized, controlled trials of educational programs for the self-management of asthma among children and adolescents, identified from the databases of Cochrane Airways Group and PsychINFO and from reference lists of review articles and eligible studies.
The eligible, randomized, controlled trials for children and adolescents reported lung function, morbidity, self-perception of asthma control, or utilization of health care services. Eligible studies were abstracted, assessed for methodologic quality, and pooled with fixed-effects and random-effects models.
Thirty-two of 45 identified trials were eligible, with a total of 37 006 patients 2 to 18 years of age. Education regarding asthma was associated with improvements in lung function (standardized mean difference: 0.50; 95% confidence interval [CI]: 0.25–0.75) and self-efficacy (mean difference: 0.36; 95% CI: 0.15–0.57) and reductions in absenteeism from school (mean difference: −0.14; 95% CI: −0.23 to −0.04), number of days of restricted activity (mean difference: −0.29; 95% CI: −0.33 to −0.09), and number of visits to an emergency department (mean difference: −0.21; 95% CI: −0.33 to −0.09). When pooled with a fixed-effects model but not a random-effects model, education was also associated with a reduced number of nights disturbed by asthma. The effects on morbidity were greatest for programs with strategies based on peak flow, interventions targeted at the individual, and participants with severe asthma.
Educational programs for the self-management of asthma among children and adolescents improve lung function and feelings of self-control and reduce absenteeism from school, number of days of restricted activity, number of visits to an emergency department, and possibly number of disturbed nights. Educational programs should be considered part of the routine care of young people with asthma.
In the early 1990s, a meta-analysis found no evidence of reductions in morbidity or utilization of health care resources associated with educational programs. However, several rigorous evaluations of educational programs have been completed in the past decade. This meta-analysis provides encouraging evidence that our educational efforts regarding self-management of asthma improve lung function, reduce morbidity, and decrease utilization of emergency health care resources. Such programs should be considered routine in the care of children and adolescents with asthma.