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. 2007 Jul 18;2007(3):CD003000.
doi: 10.1002/14651858.CD003000.pub2.

Education interventions for adults who attend the emergency room for acute asthma

S Tapp  1 , T J Lasserson, B h Rowe
Affiliations

Education interventions for adults who attend the emergency room for acute asthma

S Tapp et al. Cochrane Database Syst Rev. .

Abstract

Background: The use of educational and behavioural interventions in the management of chronic asthma have a strong evidence base. There may be a role for educative interventions following presentation in an emergency setting in adults.

Objectives: To assess the effectiveness of educational interventions administered following an acute exacerbation of asthma leading to presentation in the emergency department.

Search strategy: We searched the Cochrane Airways Group trials register. Study authors were contacted for additional information. Searches are current to November 2006.

Selection criteria: Randomised, parallel group trials were eligible if they recruited adults (> 17 years) who had presented at an emergency department with an acute asthma exacerbation. The intervention of interest was any educational intervention (for example, written asthma management plan).

Data collection and analysis: Two review authors independently assessed trial quality and extracted data. Study authors were contacted for additional information.

Main results: Twelve studies involving 1954 adults were included. Education significantly reduced subsequent admission to hospital (relative risk 0.50; 95% confidence interval 0.27 to 0.91); however, did not significantly reduce the risk of re-presentation at emergency departments (ED) the study follow up (relative risk 0.69; 95% confidence interval 0.40 to 1.21). The lack of statistically significant differences between asthma education and control groups in terms of peak flow, quality of life, study withdrawal and days lost were hard to interpret given the low number of studies contributing to these outcomes. One study from the early 1990s measured cost and found no difference for total costs and costs related to physician visits and admissions to hospital. If data were restricted to emergency department treatment, education led to lower costs than control.

Authors' conclusions: This review found that educational interventions applied in the emergency department reduce subsequent asthma admissions to hospital. The interventions did not significantly reduce ED re-presentations; while the trend in effect favours educational interventions, the pooled results were not statistically significant. The impact of educational intervention in this context on longer term outcomes relating to asthma morbidity is unclear. Priorities for additional research in this area include assessment of health-related quality of life, lung function assessment, exploration of the relationship between socio-economic status and asthma morbidity, and better description of the intervention assessed.

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Conflict of interest statement

The authors who are involved in this review have done so without any known conflicts of interest. They are not involved with the primary studies. Dr. Rowe has received unrestricted educational grants for research, participated in industry‐sponsored research and received honoraria from the following industry sponsors with respiratory divisions: AstraZeneca, GlaxoSmithKline, Boehringer‐Ingelheim, and Abbott. None of the authors are considered paid consultants to any pharmaceutical company and do not benefit financially from the work of this review.

Dr. Rowe's research is supported by a 21st Century Canada Research Chair from the Government of Canada (Ottawa, ON).

Figures

1
1
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
2
2
Forest plot of comparison: 1 Education versus usual care, outcome: 1.1 Hospital admission/re‐admission
3
3
Graph to demonstrate that for every 100 people who undergo an educational intervention having presented with an acute asthma exacerbation, around 9 would have to be treated in order that one person would not be admitted to hospital.
4
4
Forest plot of comparison: 1 Education versus usual care, outcome: 1.4 Presentation at emergency department (end of follow up).
1.1
1.1. Analysis
Comparison 1 Education versus usual care, Outcome 1 Hospital admission/re‐admission (end of follow up).
1.2
1.2. Analysis
Comparison 1 Education versus usual care, Outcome 2 Hospitalisations for asthma per 100 persons at 12 months.
1.3
1.3. Analysis
Comparison 1 Education versus usual care, Outcome 3 Length of hospital stay (days).
1.4
1.4. Analysis
Comparison 1 Education versus usual care, Outcome 4 Presentation at emergency department (end of follow up).
1.5
1.5. Analysis
Comparison 1 Education versus usual care, Outcome 5 Mean emergency department visits/100 persons.
1.6
1.6. Analysis
Comparison 1 Education versus usual care, Outcome 6 Severe episodes of asthma.
1.7
1.7. Analysis
Comparison 1 Education versus usual care, Outcome 7 Primary care physician urgent visits.
1.8
1.8. Analysis
Comparison 1 Education versus usual care, Outcome 8 Physician visits per 100 persons.
1.9
1.9. Analysis
Comparison 1 Education versus usual care, Outcome 9 Primary care physician call outs.
1.10
1.10. Analysis
Comparison 1 Education versus usual care, Outcome 10 Scheduled clinic attendance.
1.11
1.11. Analysis
Comparison 1 Education versus usual care, Outcome 11 Mean number of physician visits.
1.12
1.12. Analysis
Comparison 1 Education versus usual care, Outcome 12 FEV1.
1.13
1.13. Analysis
Comparison 1 Education versus usual care, Outcome 13 PEF [Litres/min].
1.14
1.14. Analysis
Comparison 1 Education versus usual care, Outcome 14 Asthma symptom scores.
1.15
1.15. Analysis
Comparison 1 Education versus usual care, Outcome 15 Quality of life (SGRQ).
1.16
1.16. Analysis
Comparison 1 Education versus usual care, Outcome 16 Missed school/work due to asthma (end of follow up).
1.17
1.17. Analysis
Comparison 1 Education versus usual care, Outcome 17 Mean work days missed.
1.18
1.18. Analysis
Comparison 1 Education versus usual care, Outcome 18 Days of limited activity due to asthma per 100 asthma at 12 months.
1.19
1.19. Analysis
Comparison 1 Education versus usual care, Outcome 19 Asthma caused physical limitations.
1.20
1.20. Analysis
Comparison 1 Education versus usual care, Outcome 20 Asthma caused sleep problems.
1.21
1.21. Analysis
Comparison 1 Education versus usual care, Outcome 21 Asthma caused emotional problems.
1.22
1.22. Analysis
Comparison 1 Education versus usual care, Outcome 22 Asthma caused social difficulties.
1.23
1.23. Analysis
Comparison 1 Education versus usual care, Outcome 23 Self‐management techniques.
1.24
1.24. Analysis
Comparison 1 Education versus usual care, Outcome 24 Adequate self‐management techniques.
1.25
1.25. Analysis
Comparison 1 Education versus usual care, Outcome 25 Cost ($).
1.26
1.26. Analysis
Comparison 1 Education versus usual care, Outcome 26 Study withdrawal/loss to follow up.
2.1
2.1. Analysis
Comparison 2 Sensitivity analysis, Outcome 1 Hospital admission/readmission (end of follow‐up); studies at low risk of selection bias (allocation generation and concealment).
2.2
2.2. Analysis
Comparison 2 Sensitivity analysis, Outcome 2 Presentation at emergency department (end of follow up).
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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Marabini 2002 {published data only}
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McDonald 1998 {published data only}
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Mulloy 1996 {published data only}
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Schatz 2006 {published data only}
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Segura 2001 {published data only}
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Singh 2001 {published data only}
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Smith 2005a {published data only}
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References to studies awaiting assessment

Sittipunt 2008 {unpublished data only}
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References to ongoing studies

NHLBI 2005 {published data only}
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Partridge 2002 {published data only}
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Partridge 2003 {published data only}
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Partridge 2003a {published data only}
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