Family therapy for asthma in children

 

Abstract

Background

Psychosocial and emotional factors are important in childhood asthma. Nevertheless, drug therapy alone continues to be the main treatment. Treatment programmes that include behavioural or psychological interventions have been developed to improve disturbed family relations in the families of children with severe asthma. These approaches have been extended to examine the efficacy of family therapy to treat childhood asthma in a wider group of patients. This review systematically examines these studies.

Objectives

Recognition that asthma can be associated with emotional disturbances has led to the investigation of the role of family therapy in reducing the symptoms and impact of asthma in children. The objective of this review was to assess the effects of family therapy as an adjunct to medication for the treatment of asthma in children.

Search methods

We searched the Cochrane Airways Group Specialised Register of trials, and checked the reference lists in trial reports and review articles. The most recent search was carried out in January 2007.

Selection criteria

Randomised trials comparing children undergoing systematic therapy focusing on the family in conjunction with asthma medication, with children taking asthma medication only.

Data collection and analysis

Two reviwers (JY and CS) applied the study inclusion criteria.

Main results

Two trials with a total of 55 children were included. It was not possible to combine the findings of these two studies because of differences in outcome measures used. In one study, gas volume, peak expiratory flow rate and daytime wheeze showed improvement in family therapy patients compared to controls. In the other study, there was an improvement in overall clinical assessment and number of functionally impaired days in the patients receiving family therapy. There was no difference in forced expiratory volume or medication use in both studies.

Authors' conclusions

There is some indication that family therapy may be a useful adjunct to medication for children with asthma. This conclusion is limited by small study sizes and lack of standardisation in the choice of outcome measures.

 

Plain language summary

Family therapy for asthma in children

Psychological factors may have an effect on asthma in children, or its severity. As some children with families who are having problems have severe asthma, family therapy has been tried. The aim is to resolve any problems there might be in a family, in case they are causing the child stress and then making asthma worse. The review found some evidence from two trials that family therapy (in addition to standard asthma treatments) might help reduce a child's asthma symptoms, but more research is needed to be certain.

 

摘要

背景

氣喘病童的家庭療法

心理及情緒因素對兒童期氣喘很重要，雖然單獨藥物治療仍然是主要治療方式。包括行為或心理介入的治療計劃已發展成改善患有嚴重氣喘病童的受損家庭關係。這些療法已被延伸至更多的氣喘病童，以評估家庭療法對治療兒童期氣喘的效果。此回顧以系統性方式檢視這些研究。

目標

發現氣喘可能跟情緒干擾有關，引起了對家庭療法可減輕兒童氣喘的症狀及沖擊的角色的探討。此回顧的目的在於評估家庭療法作為兒童氣喘藥物療法的輔助療法的效果。

搜尋策略

我們搜尋了the Cochrane Airways Group Specialised Register of trials及檢視了這些試驗及回顧文章的參考目錄。最近期的搜尋在2007年1月進行。

選擇標準

比較同時接受藥物及家庭療法和只接受藥物療法的氣喘病童的隨機試驗

資料收集與分析

兩位回顧者(JY 及 CS)應用了此回顧的納入標準。

主要結論

兩個包括了55位兒童的試驗被納入，但無法結合彼此的結果，因為其結果設定不同。其中一個研究當中，與控制組比較，氣體容積，最高呼氣流速(peak exporatory flow rate)及日間喘鳴在家庭療法組有改善；在另一個研究當中，接受家庭療法的病人組在各項臨床評估及功能受損的天數都有改善，而強迫呼氣容積(Forced expiratory volume)或藥物使用在此兩個研究當中沒有差異。

作者結論

家庭療法成為藥物治療氣喘病童的有效輔助療法有一些條件。此結論受限於研究規模小及缺乏標準結果選用。

翻譯人

本摘要由國泰綜合醫院尹丹桂翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

部份證據顯示家庭療法有效改善氣氣喘病童的病情，但仍需要更進一步的研究。心理因素可能對氣喘病童或氣喘的嚴重程度有影響。家庭療法被嘗試使用在某些生長於問題家庭的氣喘病童，其氣喘的程度嚴重。目的在於試著解決任何可能導致病童壓力上升以致氣喘病情惡化的問題。此回顧從兩個試驗中找到一些證據(作為標準氣喘治療的輔助)，可能可幫助減輕兒童氣喘症狀，但需要更多進一步的研究確認。