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Liu WY, Jiesisibieke ZL, Tung TH. Effect of asthma education on health outcomes in children: a systematic review. Arch Dis Child 2022; 107:1100-1105. [PMID: 35197244 PMCID: PMC9685736 DOI: 10.1136/archdischild-2021-323496] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/08/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND It remains unknown whether child-oriented asthma education is associated with better health outcomes. This meta-analysis investigated the effects of asthma education on hospitalisation and emergency department and clinic visits. METHODS We searched the Cochrane Library, PubMed and EMBASE for relevant studies from inception to 4 July 2021, and selected studies that reported hospitalisation or emergency department or clinic visits as outcomes. The participants were only children. Two authors independently selected the studies, assessed the quality of the included studies and retrieved the data. A third senior author was engaged to resolve disagreements. Fifteen longitudinal studies were included for the systematic review and meta-analysis. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 was used as the standard of reporting (PRISMA registration ID is 284509). FINDINGS Compared with the control group, the asthma education group had 54% lower hospitalisation risk (95% CI 0.32 to 0.66), and 31% lower emergency department visit risk (95% CI 0.59 to 0.81). Sensitivity analysis showed that the asthma education group had a reduced clinic visit risk (risk ratio (RR)=0.80, 95% CI 0.67 to 0.97). Subgroup analysis showed that asthma education involving both children and parents/guardians was associated with fewer hospitalisations (RR=0.38, 95% CI 0.24 to 0.59) and emergency department visits (RR=0.69, 95% CI 0.57 to 0.83). Asthma education in hospitals or non-hospitals can reduce the risk of hospitalisation and emergency department visits. However, only education in the hospitals was associated with the reduction of clinical visits (RR=0.45, 95% CI 0.22 to 0.92). INTERPRETATION Education is effective for controlling asthma, especially for reducing hospitalisation and emergency department and clinic visits. Education involving both children and parents/guardians is more effective than that involving only children. The setting of asthma education does not impact its effect to a large extent.
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Affiliation(s)
- Wen-Yi Liu
- Department of Health Policy Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA,Institute for Hospital Management, Tsing Hua University, Shenzhen Campus, China,Shanghai Bluecross Medical Science Institute, Shanghai, China
| | | | - Tao-Hsin Tung
- Evidence-based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang Province, China
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Beerthuizen T, Rikkers-Mutsaerts ERVM, Snoeck-Stroband JB, Sont JK. The Role of Education, Monitoring, and Symptom Perception in Internet-Based Self-management Among Adolescents With Asthma: Secondary Analysis of a Randomized Controlled Trial. JMIR Pediatr Parent 2021; 4:e17959. [PMID: 34879001 PMCID: PMC8693204 DOI: 10.2196/17959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 12/31/2020] [Accepted: 06/01/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Internet-based self-management programs improve asthma control and the asthma-related quality of life in adults and adolescents. The components of self-management programs include education and the web-based self-monitoring of symptoms; the latter requires adequate perception in order to timely adjust lifestyle or medication or to contact a care provider. OBJECTIVE We aimed to test the hypothesis that adherence to education and web-based monitoring and adequate symptom perception are important determinants for the improvement of asthma control in self-management programs. METHODS We conducted a subgroup analysis of the intervention group of a randomized controlled trial, which included adolescents who participated in the internet-based self-management arm. We assessed the impacts that attendance in education sessions, the frequency of web-based monitoring, and the level of perception had on changes in asthma control (Asthma Control Questionnaire [ACQ]) and asthma-related quality of life (Pediatric Asthma Quality of Life Questionnaire) from baseline to 12 months after intervention. RESULTS Adolescents who attended education sessions had significant and clinically relevant improvements in asthma control (ACQ score difference: -0.6; P=.03) and exhibited a nonsignificant trend of improvement in asthma-related quality of life (Pediatric Asthma Quality of Life Questionnaire score difference: -0.45; P=.15) when compared to those who did not adhere to education. Frequent monitoring alone did not improve asthma control (P=.07) and quality of life (P=.44) significantly, but its combination with education did result in improved ACQ scores (difference: -0.88; P=.02). There were no significant differences in outcomes between normoperceivers and hypoperceivers. CONCLUSIONS Education, especially in combination with frequent web-based monitoring, is an important determinant for the 1-year outcomes of asthma control in internet-based self-management programs for adolescents with partly controlled and uncontrolled asthma; however, we could not establish the effect of symptom perception. This study provides important knowledge on the effects of asthma education and monitoring in daily life.
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Affiliation(s)
- Thijs Beerthuizen
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, Netherlands
| | | | - Jiska B Snoeck-Stroband
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, Netherlands
| | - Jacob K Sont
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, Netherlands
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Kelada L, Molloy CJ, Hibbert P, Wiles LK, Gardner C, Klineberg E, Braithwaite J, Jaffe A. Child and caregiver experiences and perceptions of asthma self-management. NPJ Prim Care Respir Med 2021; 31:42. [PMID: 34504105 PMCID: PMC8429661 DOI: 10.1038/s41533-021-00253-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 08/19/2021] [Indexed: 02/07/2023] Open
Abstract
Asthma is the most common chronic condition of childhood. Self-management is integral to good asthma control. This qualitative paper explores how children with asthma and their parents perceive asthma, their experience with asthma, and how they manage symptoms, preventions and medications within and outside the home. We undertook 15 focus groups with 41 school-aged (6-11 years) children with asthma and 38 parents. Parents and their children attended the same focus groups. We used thematic analysis to analyse the transcripts. Our findings show the impact asthma can have on children's social and emotional wellbeing and highlight how reliant school-aged children are on their parents to effectively manage their asthma. Parents reported being unsure when their child's symptoms warranted visiting their doctor or hospital. Schools were identified as a source of difficulty regarding asthma management; families reported that children may be self-conscious about their asthma and using their inhaler at school. School policies and teachers' lack of asthma knowledge were reported to exacerbate children's reluctance to use their inhaler at school. Our results have implications for the design and implementation of children's self-management interventions for their asthma, particularly when they are at school and away from their parents.
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Affiliation(s)
- Lauren Kelada
- grid.1005.40000 0004 4902 0432School of Women’s and Children’s Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW Australia ,grid.414009.80000 0001 1282 788XKids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW Australia
| | - Charlotte J. Molloy
- grid.1004.50000 0001 2158 5405Australian Institute of Health Innovation, Macquarie University, Sydney, NSW Australia ,grid.1026.50000 0000 8994 5086Australian Centre for Precision Health, Cancer Research Institute, School of Health Sciences, University of South Australia, Adelaide, SA Australia ,grid.430453.50000 0004 0565 2606South Australian Health and Medical Research Institute, Adelaide, SA Australia
| | - Peter Hibbert
- grid.1004.50000 0001 2158 5405Australian Institute of Health Innovation, Macquarie University, Sydney, NSW Australia ,grid.1026.50000 0000 8994 5086Australian Centre for Precision Health, Cancer Research Institute, School of Health Sciences, University of South Australia, Adelaide, SA Australia ,grid.430453.50000 0004 0565 2606South Australian Health and Medical Research Institute, Adelaide, SA Australia
| | - Louise K. Wiles
- grid.1004.50000 0001 2158 5405Australian Institute of Health Innovation, Macquarie University, Sydney, NSW Australia ,grid.1026.50000 0000 8994 5086Australian Centre for Precision Health, Cancer Research Institute, School of Health Sciences, University of South Australia, Adelaide, SA Australia ,grid.430453.50000 0004 0565 2606South Australian Health and Medical Research Institute, Adelaide, SA Australia
| | - Claire Gardner
- grid.1026.50000 0000 8994 5086Australian Centre for Precision Health, Cancer Research Institute, School of Health Sciences, University of South Australia, Adelaide, SA Australia ,grid.1014.40000 0004 0367 2697Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA Australia
| | - Emily Klineberg
- grid.416088.30000 0001 0753 1056Ministry of Health, NSW Health, St Leonards, NSW Australia
| | - Jeffrey Braithwaite
- grid.1004.50000 0001 2158 5405Australian Institute of Health Innovation, Macquarie University, Sydney, NSW Australia
| | - Adam Jaffe
- grid.1005.40000 0004 4902 0432School of Women’s and Children’s Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW Australia ,grid.414009.80000 0001 1282 788XRespiratory Department, Sydney Children’s Hospital, Randwick, NSW Australia ,grid.414009.80000 0001 1282 788XAiming for Asthma Improvement in Children, Sydney Children’s Hospital, Randwick, NSW Australia
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Guarnaccia S, Quecchia C, Festa A, Magoni M, Zenoni G, D'Agata E, Brivio V, Zanardini E, Scarcella C, Gretter V, Facchetti S, Gasparotti C, Pluda A, Frassine M, Limina RM, Spiazzi R, Badolato R, Bender B, Donato F. Impact of a diagnostic therapeutic educational pathway program for asthma management in preschool children. Ital J Pediatr 2021; 47:60. [PMID: 33691759 PMCID: PMC7944593 DOI: 10.1186/s13052-021-00992-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 02/16/2021] [Indexed: 12/22/2022] Open
Abstract
Background Preschool children with clinically-diagnosed asthma have a higher rate of emergency department visits and consume more resources for management than older children. However, no clinical trials have yet been performed measuring the impact of a combined diagnostic, therapeutic and educational pathway regimen for evaluation of wheezing control in children aged less than 6 years. The purpose of the present study was to assess the impact of a pediatric program developed in Italy, the Diagnostic Therapeutic Educational Pathway (DTEP), for asthma management in children less than 6 years old attending an asthma referral center. Methods This is a retrospective population-based cohort study performed in children with asthma aged 0–5 years, attending at “Io e l’Asma center”, Brescia, Italy between September 2007 and December 2014. The incidence rates (IRs) of hospitalization, emergency room visits, use of outpatient services and drug usage for dyspnea, wheezing, or respiratory symptoms were evaluated for time periods prior to and after DTEP intervention. Results A total of 741 patients, aged 0–5 years completed the DTEP, including 391 and 350 children aged 0–2 and 3–5 years, respectively. The percentage of children aged 0–2 and 3–5 years showing improved control of wheezing symptoms during the 1st to 3rd visit interval as a result of the DTEP intervention increased from 39.5 to 60.9% and from 25.5 to 75.5%, respectively. During these periods, the IRs showed a significant decrease for all outcomes, from-8.6% to − 80.4%. Although specific IRs for drug prescriptions declined, particularly for LABA plus corticosteroids, antibiotics, and systemic corticosteroids, they increased for SABA, inhaled corticosteroid and leukotriene receptor antagonist usage. Conclusions The results suggest that a real-world assessment of the integrated DTEP program for preschool children provides evidence for improved wheezing control and reduction of adverse therapeutic related outcomes.
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Affiliation(s)
- Sebastiano Guarnaccia
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
| | - Cristina Quecchia
- Centro "Io e l'Asma", Ospedale dei Bambini, ASST Spedali Civili, Brescia, Italy
| | - Andrea Festa
- Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, University of Brescia, Brescia, Italy
| | | | - Giuseppe Zenoni
- Post-Graduate School of Public Health, University of Brescia, Brescia, Italy
| | - Emanuele D'Agata
- Centro "Io e l'Asma", Ospedale dei Bambini, ASST Spedali Civili, Brescia, Italy
| | - Valentina Brivio
- Post-Graduate School of Public Health, University of Brescia, Brescia, Italy
| | - Elena Zanardini
- Post-Graduate School of Public Health, University of Brescia, Brescia, Italy
| | | | - Valeria Gretter
- Centro "Io e l'Asma", Ospedale dei Bambini, ASST Spedali Civili, Brescia, Italy
| | - Susanna Facchetti
- Centro "Io e l'Asma", Ospedale dei Bambini, ASST Spedali Civili, Brescia, Italy
| | | | - Ada Pluda
- Centro "Io e l'Asma", Ospedale dei Bambini, ASST Spedali Civili, Brescia, Italy
| | - Malica Frassine
- Centro "Io e l'Asma", Ospedale dei Bambini, ASST Spedali Civili, Brescia, Italy
| | | | | | - Raffaele Badolato
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Bruce Bender
- Department of Pediatrics, Center for Health Promotion National Jewish Health, Colorado, Denver, USA
| | - Francesco Donato
- Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, University of Brescia, Brescia, Italy
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