Asthma: limited education is useful only high-risk patients attending the emergency department.

Clinical bottom line (level 1a)

  1. In adults with asthma, limited asthma education programmes which provide information only, do not reduce hospitalisations, doctor visits or medication use in asthma.
  2. Limited asthma education (information only) programmes reduce emergency department visits in high-risk adults.
Gibson et al: The Cochrane Library, Issue 4. Oxford: Update Software 1999; 4: -
Expires November 2002

The study

Systematic review of controlled clinical trials of
  • Patients: patients (aged >16) with asthma
  • Intervention: limited (information only) asthma education, classified as: interactive- an education session or sessions whereby an individualised response could be made to learner stimuli; non-interactive- education material (print, audio, video, electronic) which was non-responsive to learner stimuli; combined interactive compared with usual care
  • Outcome: hospital admission, doctor visits and medication use


    • Articles found in all using Cochrane Airway's Group's register from MEDLINE, EMBASE, CINAHL, ? (search terms: (asthma OR wheeze)* AND (education* OR self management OR self-management) ) and hand searching of respiratory journals and meeting abstracts, bibliographic lists also searched

    Selection criteria: as above
    Appraisal criteria: selected and appraised by two reviewers using set criteria
    Articles excluded if:
    • peak expiratory flow monitoring and diary recording
    • provision of a written action plan, which was defined as: individualised written plan informing participants about when and how to modify medications in response to worsening asthma, or assessment and or modification of medical therapy


    Eleven randomised controlled trials were found; 8 provided data on re hospitalisation (906 patients), 4 on repeat ER visits and 5 trials (1114 patients) provided data on doctor visits.
    There was no significant heterogeneity.

    The evidence

    • hospitalisations per year: weighted mean difference, -0.029 (95% CI: -0.085 to 0.029)
    • emergency department visits per year in high-risk patients: weighted mean difference, 2.8 (95% CI: 1.2 to 4.3)
    • doctor visits per year: weighted mean difference, 0.22 (95% CI: -0.085 to 0.52)
    • no effect noted on steroid courses or other rescue medication used.

    Comments

    1. Overall, the studies showed no effect of limited asthma education (information only) on the more objective measures (days lost) but did find positive effects on perceived asthma symptoms.
    2. This data suggests we should look for more effective ways to enable patients to take control of their asthma, as brief education alone is clearly insufficient.

    Citation

    1. Gibson PG, Coughlan J, Wilson AJ, et al: The effect of limited (information only) patient education programs on the health outcomes of adults with asthma (Cochrane review). The Cochrane Library, Issue 4. Oxford: Update Software 1999; 4: -
    Search Terms: education and asthma in Cochrane
    Contributor: Chris Ball and Clare Wotton, June 2000
    Reviewer: Peter Wark

    Clinical Question.
    Patient adults with asthma
    Intervention or Exposure education programme
    Comparison usual care
    Outcome hospitalisations