Family therapy for chronic 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 strategy: We searched the Cochrane Airways Group trials register, Psychlit and Psychinfo. Searches are current as of January 2005.

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 reviewers assessed the studies for inclusion in the review.

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.

1.1. Analysis

Comparison 1 FAMILY THERAPY & DRUG THERAPY vs DRUG THERAPY ALONE, Outcome 1 General paediatric assessment ‐ no improvement.

1.2. Analysis

Comparison 1 FAMILY THERAPY & DRUG THERAPY vs DRUG THERAPY ALONE, Outcome 2 General paediatric assessment ‐ deterioration.

1.3. Analysis

Comparison 1 FAMILY THERAPY & DRUG THERAPY vs DRUG THERAPY ALONE, Outcome 3 Functionally impaired days ‐ no improvement.

1.4. Analysis

Comparison 1 FAMILY THERAPY & DRUG THERAPY vs DRUG THERAPY ALONE, Outcome 4 Functionally impaired days ‐ deterioration.

1.5. Analysis

Comparison 1 FAMILY THERAPY & DRUG THERAPY vs DRUG THERAPY ALONE, Outcome 5 Nights B2 inhalers used ‐ no improvement.

1.6. Analysis

Comparison 1 FAMILY THERAPY & DRUG THERAPY vs DRUG THERAPY ALONE, Outcome 6 Nights B2 inhalers used ‐ deterioration.

1.7. Analysis

Comparison 1 FAMILY THERAPY & DRUG THERAPY vs DRUG THERAPY ALONE, Outcome 7 Peak expiratory flow rate ‐ no improvement.

1.8. Analysis

Comparison 1 FAMILY THERAPY & DRUG THERAPY vs DRUG THERAPY ALONE, Outcome 8 Peak expiratory flow rate ‐ deterioration.

1.9. Analysis

Comparison 1 FAMILY THERAPY & DRUG THERAPY vs DRUG THERAPY ALONE, Outcome 9 Peak expiratory flow rate ‐ pre‐medication, morning.

1.10. Analysis

Comparison 1 FAMILY THERAPY & DRUG THERAPY vs DRUG THERAPY ALONE, Outcome 10 Peak expiratory flow rate ‐ pre‐medication, evening.

1.11. Analysis

Comparison 1 FAMILY THERAPY & DRUG THERAPY vs DRUG THERAPY ALONE, Outcome 11 Forced expiratory volume ‐ (in 0.75 seconds).

1.12. Analysis

Comparison 1 FAMILY THERAPY & DRUG THERAPY vs DRUG THERAPY ALONE, Outcome 12 Thoracic gas volume.

1.13. Analysis

Comparison 1 FAMILY THERAPY & DRUG THERAPY vs DRUG THERAPY ALONE, Outcome 13 Day wheeze.

1.14. Analysis

Comparison 1 FAMILY THERAPY & DRUG THERAPY vs DRUG THERAPY ALONE, Outcome 14 Activity.