Educational interventions for asthma in children

  • Review
  • Intervention

Authors


Abstract

Background

Self-management education programs have been developed for children with asthma, but it is unclear whether such programs improve outcomes.

Objectives

To determine the efficacy of asthma self-management education on health outcomes in children.

Search methods

Systematic search of the Cochrane Airways Group's Special Register of Controlled Trials and PSYCHLIT, and hand searches of the reference lists of relevant review articles.

Selection criteria

Randomized and controlled clinical trials of asthma self-management education programs in children and adolescents aged 2 to 18 years.

Data collection and analysis

All studies were assessed independently by two reviewers. Disagreements were settled by consensus. Study authors were contacted for missing data or to verify methods. Subgroup analyses examined the impact of type and intensity of educational intervention, self-management strategy, trial type, asthma severity, adequacy of follow-up, and study quality.

Main results

Of 45 trials identified, 32 studies involving 3706 patients were eligible. Asthma education programs were associated with moderate improvement in measures of airflow (standardized mean difference [SMD] 0.50, 95% confidence interval [CI] 0.25 to 0.75) and self-efficacy scales (SMD 0.36, 95% CI 0.15 to 0.57). Education programs were associated with modest reductions in days of school absence (SMD -0.14, 95% CI -0.23 to -0.04), days of restricted activity (SMD -0.29, 95% CI -0.49 to -0.08), and emergency room visits (SMD -0.21, 95% CI -0.33 to -0.09). There was a reduction in nights disturbed by asthma when pooled using a fixed-effects but not a random-effects model. Effects of education were greater for most outcomes in moderate-severe, compared with mild-moderate asthma, and among studies employing peak flow versus symptom-based strategies. Effects were evident within the first six months, but for measures of morbidity and health care utilization, were more evident by 12 months.

Authors' conclusions

Asthma self-management education programs in children improve a wide range of measures of outcome. Self-management education directed to prevention and management of attacks should be incorporated into routine asthma care. Conclusions about the relative effectiveness of the various components are limited by the lack of direct comparisons. Future trials of asthma education programs should focus on morbidity and functional status outcomes, including quality of life, and involve direct comparisons of the various components of interventions.

摘要

背景

教育介入對氣喘兒童的影響

為氣喘兒所設計的自我管理教育計劃已經建立了,但不清楚這些程序能如何改善其結果。

目標

要確定氣喘自我管理教育系統對兒童的健康狀態的效益。

搜尋策略

系統性的搜尋the Cochrane Airways Group's Special Register of Controlled Trials及PSYCHLIT並且手工搜尋有關評估文章的參考文獻目錄。

選擇標準

納入針對2歲到18歲的兒童和青少年氣喘自我管理教育計劃的隨機對照臨床試驗。

資料收集與分析

所有的研究透過兩個評估人員獨立審評。不同的意見經由產生共識來解決。聯繫了研究的作者以獲得缺少的數據或驗證其方法。小分組分析研究了影響的教育干預的類型和強度,自我管理的策略,試驗的類型,氣喘的嚴重程度,充足的後續行動,和研究的品質。

主要結論

在被找到的45個試驗中,32個研究包含3706的合格病人。氣喘教育課程有溫和的改善其測量氣流(標準化平均差[SMD] 0.50,95%信賴區間[CI] 0.25至0.75)和自我效益評量表(SMD 0.36,95%CI為0.15~0.57)。教育課程有適度的減少缺課天數(SMD −0.14,95%CI為 −0.23至−0.04),限制活動的天數(SMD 0.29,95%CI為 −0.49至0.08),和急診治療的頻率(SMD 0.21,95%CI為 −0.33至−0.09)。對於晚間發作氣喘有減少,當使用使用固定效果而不是隨機效果方式分析。在與輕中度氣喘相比的中重度病患及以尖峰流量相對於症狀為基礎的策略研究中,大部分分析結果顯示教育的影響較大。效果在起初6個月很明顯,但發病率的測量和醫療保健的利用則於12個月間均很明顯。

作者結論

兒童的氣喘自我管理教育程式改善了範圍廣泛的測量結果。自我管理教育指出氣喘發病的預防和管理需和常規護理配合。有關於相對有效性的各個因素的結論是有限的因為缺乏直接的比較。之後氣喘教育計劃的試驗應側重於發病率和功能性狀態的結果,包含了生活品質並包含直接比較干預措施的各個因素。

翻譯人

本摘要由臺北醫學大學萬芳醫院劉怡敏翻譯。

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

總結

學習與氣喘有關的預防或發作管理的自我管理策略可以幫助改善兒童的肺功能和自我控制的感覺,並減少缺課和限制活動天數,減少急診室的利用率。對於住院的風險或頻率與一般的護理和照顧輔以自我管理教育來說則無差別。更為罕見且嚴重的事件類型可能超出教育影響的能力。當越來越多的研究需要直接進行不同類型的干預措施的比較,目前有限的證據顯示在一般狀況下,自我管理教育工作對於患有中度至重度氣喘的人以及那些輕度到中度氣喘的人效果一樣良好。以尖峰流量為基礎的教育策略普遍比起以症狀為基礎的教育測略有更大的成效。6個月內的生理功能測量值顯示是有益於病患的,但是直到教育招生計劃的7至12個月後,對發病率的量測或衛生服務使用率的效果並未完全顯現。

Plain language summary

Educational interventions for asthma in children

Learning self-management strategies related to asthma prevention or attack management can help improve children's lung function and feelings of self-control, as well as reduce school absences and days of restricted activity and decrease emergency room utilization. There were no differences in the risk or frequency of hospitalizations between usual care and care supplemented with self-management education. These types of more rare and serious events may be beyond the ability of education to influence. While more research is needed to make direct comparisons between different types of interventions, the limited evidence currently available suggests that in general, self-management education works well for persons with moderate-to-severe asthma as well as for those with mild-to-moderate asthma. Peak flow-based educational strategies generally show greater effects than symptom-based strategies. Beneficial effects on measures of physiological function were apparent within six months, but benefits did not become fully apparent on measures of morbidity or health care utilization until 7 to 12 months following enrolment in an educational program.

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