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Meta-Analysis
. 2019 Jan 28;1(1):CD011651.
doi: 10.1002/14651858.CD011651.pub2.

School-based self-management interventions for asthma in children and adolescents: a mixed methods systematic review

Katherine Harris  1 , Dylan Kneale, Toby J Lasserson, Vanessa M McDonald, Jonathan Grigg, James Thomas
Affiliations
Meta-Analysis

School-based self-management interventions for asthma in children and adolescents: a mixed methods systematic review

Katherine Harris et al. Cochrane Database Syst Rev. .

Abstract

Background: Asthma is a common respiratory condition in children that is characterised by symptoms including wheeze, shortness of breath, chest tightness, and cough. Children with asthma may be able to manage their condition more effectively by improving inhaler technique, and by recognising and responding to symptoms. Schools offer a potentially supportive environment for delivering interventions aimed at improving self-management skills among children. The educational ethos aligns with skill and knowledge acquisition and makes it easier to reach children with asthma who do not regularly engage with primary care. Given the multi-faceted nature of self-management interventions, there is a need to understand the combination of intervention features that are associated with successful delivery of asthma self-management programmes.

Objectives: This review has two primary objectives.• To identify the intervention features that are aligned with successful intervention implementation.• To assess effectiveness of school-based interventions provided to improve asthma self-management among children.We addressed the first objective by performing qualitative comparative analysis (QCA), a synthesis method described in depth later, of process evaluation studies to identify the combination of intervention components and processes that are aligned with successful intervention implementation.We pursued the second objective by undertaking meta-analyses of outcomes reported by outcome evaluation studies. We explored the link between how well an intervention is implemented and its effectiveness by using separate models, as well as by undertaking additional subgroup analyses.

Search methods: We searched the Cochrane Airways Trials Register for randomised studies. To identify eligible process evaluation studies, we searched MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, the Cochrane Database of Systematic Reviews (CDSR), Web of Knowledge, the Database of Promoting Health Effectiveness Reviews (DoPHER), the Database of Abstracts of Reviews of Effects (DARE), the International Biography of Social Science (IBSS), Bibliomap, Health Technology Assessment (HTA), Applied Social Sciences Index and Abstracts (ASSIA), and Sociological Abstracts (SocAbs). We conducted the latest search on 28 August 2017.

Selection criteria: Participants were school-aged children with asthma who received the intervention in school. Interventions were eligible if their purpose was to help children improve management of their asthma by increasing knowledge, enhancing skills, or changing behaviour. Studies relevant to our first objective could be based on an experimental or quasi-experimental design and could use qualitative or quantitative methods of data collection. For the second objective we included randomised controlled trials (RCTs) where children were allocated individually or in clusters (e.g. classrooms or schools) to self-management interventions or no intervention control.

Data collection and analysis: We used qualitative comparative analysis (QCA) to identify intervention features that lead to successful implementation of asthma self-management interventions. We measured implementation success by reviewing reports of attrition, intervention dosage, and treatment adherence, irrespective of effects of the interventions.To measure the effects of interventions, we combined data from eligible studies for our primary outcomes: admission to hospital, emergency department (ED) visits, absence from school, and days of restricted activity due to asthma symptoms. Secondary outcomes included unplanned visits to healthcare providers, daytime and night-time symptoms, use of reliever therapies, and health-related quality of life as measured by the Asthma Quality of Life Questionnaire (AQLQ).

Main results: We included 55 studies in the review. Thirty-three studies in 14,174 children provided information for the QCA, and 33 RCTs in 12,623 children measured the effects of interventions. Eleven studies contributed to both the QCA and the analysis of effectiveness. Most studies were conducted in North America in socially disadvantaged populations. High school students were better represented among studies contributing to the QCA than in studies contributing to effectiveness evaluations, which more commonly included younger elementary and junior high school students. The interventions all attempted to improve knowledge of asthma, its triggers, and stressed the importance of regular practitioner review, although there was variation in how they were delivered.QCA results highlighted the importance of an intervention being theory driven, along with the importance of factors such as parent involvement, child satisfaction, and running the intervention outside the child's own time as drivers of successful implementation.Compared with no intervention, school-based self-management interventions probably reduce mean hospitalisations by an average of about 0.16 admissions per child over 12 months (SMD -0.19, 95% CI -0.35 to -0.04; 1873 participants; 6 studies, moderate certainty evidence). They may reduce the number of children who visit EDs from 7.5% to 5.4% over 12 months (OR 0.70, 95% CI 0.53 to 0.92; 3883 participants; 13 studies, low certainty evidence), and probably reduce unplanned visits to hospitals or primary care from 26% to 21% at 6 to 9 months (OR 0.74, 95% CI 0.60 to 0.90; 3490 participants; 5 studies, moderate certainty evidence). Self-management interventions probably reduce the number of days of restricted activity by just under half a day over a two-week period (MD 0.38 days 95% CI -0.41 to -0.18; 1852 participants; 3 studies, moderate certainty evidence). Effects of interventions on school absence are uncertain due to the variation between the results of the studies (MD 0.4 fewer school days missed per year with self-management (-1.25 to 0.45; 4609 participants; 10 studies, low certainty evidence). Evidence is insufficient to show whether the requirement for reliever medications is affected by these interventions (OR 0.52, 95% CI 0.15 to 1.81; 437 participants; 2 studies; very low-certainty evidence). Self-management interventions probably improve children's asthma-related quality of life by a small amount (MD 0.36 units higher on the Paediatric AQLQ(95% CI 0.06 to 0.64; 2587 participants; 7 studies, moderate certainty evidence).

Authors' conclusions: School-based asthma self-management interventions probably reduce hospital admission and may slightly reduce ED attendance, although their impact on school attendance could not be measured reliably. They may also reduce the number of days where children experience asthma symptoms, and probably lead to small improvements in asthma-related quality of life. Many of the studies tested the intervention in younger children from socially disadvantaged populations. Interventions that had a theoretical framework, engaged parents and were run outside of children's free time were associated with successful implementation.

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Conflict of interest statement

A grant from NIHR North Thames CLAHRC is supporting some of this work, although it is not contributing to any individual time spent on the review (James Thomas).

This paper presents independent research and was funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) North Thames at Bart's Health NHS Trust.

The views expressed are those of the review author(s) and are not necessarily those of the NHS, the NIHR, or the Department of Health.

Figures

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1
Logic model of school‐based asthma interventions.
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Process evaluation study flow diagram.
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Outcome evaluation study flow diagram.
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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
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Forest plot of comparison: 1 School‐based asthma interventions vs usual care: outcome: 1.1. Exacerbations leading to hospitalisation.
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Forest plot of comparison: 1. Effect of school‐based asthma interventions vs usual care, outcome: 1.2. Exacerbations leading to emergency department (ED) visits.
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Forest plot of comparison: 2. Effect of school‐based asthma interventions vs usual care subgrouped by school type, outcome: 2.1. Exacerbations leading to emergency department (ED) visits.
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Forest plot of comparison: 1. Effect of school‐based asthma interventions vs usual care, outcome: 1.3. Absence from school.
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Forest plot of comparison: 2. Effect of school‐based asthma interventions vs usual care subgrouped by school type, outcome: 2.2. Absence from school.
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Forest plot of comparison: 10. Effect of school‐based asthma interventions vs usual care subgrouped by configuration of conditions (iI), outcome: 10.3. Absence from school.
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Forest plot of comparison: 1. Effect of school‐based asthma interventions vs usual care, outcome: 1.4. Days of restricted activity.
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Forest plot of comparison: 1. Effect of school‐based asthma interventions vs usual care, outcome: 1.5. Unplanned visit to hospital or GP due to asthma symptoms.
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Forest plot of comparison: 1. Effect of school‐based asthma interventions vs usual care, outcome: 1.6. Experience of daytime and night‐time symptoms ‐ daytime symptoms.
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Forest plot of comparison: 1. Effect of school‐based asthma interventions vs usual care, outcome: 1.8. Use of reliever therapies, e.g. beta₂‐agonists.
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Forest plot of comparison: 1. Effect of school‐based asthma interventions vs usual care, outcome: 1.9. Corticosteroid dosage and/or use of add‐on therapies (usage of).
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Forest plot of comparison: 1. Effect of school‐based asthma interventions vs usual care, outcome: 1.11. Health‐related quality of life (SMD).
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Forest plot of comparison: 1. Effect of school‐based asthma interventions vs usual care, outcome: 1.13. Withdrawal from the study.
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Forest plot of comparison: 2. Effect of school‐based asthma interventions vs usual care subgrouped by school type, outcome: 2.3. Withdrawal from the study.
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Forest plot of comparison: 11. Adjunct analyses ‐ impact of Implementation on selected outcomes, outcome: 11.1. Exacerbations leading to emergency department (ED) visits.
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Forest plot of comparison: 11. Adjunct analyses ‐ impact of Implementation on selected outcomes, outcome: 11.2. Absence from school.
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    1. Terpstra JL, Chavez LJ, Ayala GX. An intervention to increase caregiver support for asthma management in middle school‐aged youth. Journal of Asthma 2012;49(3):267‐74. - PubMed
Velsor‐Friedrich 2005 {published data only}
    1. Velsor‐Friedrich B, Pigott T, Srof B. A practitioner‐based asthma intervention program with African American inner‐city school children. Journal of Pediatric Health Care 2005;19(3):163‐71. - PubMed

References to studies excluded from this review

Akasawa 2016 {published data only}
    1. Akasawa A. Asthma management in school. Japanese Journal of Allergology 2016;65(7):901‐6. - PubMed
Al Aloola 2017 {published data only}
    1. Al Aloola NA, Saba M, Nissen L, Alewairdhi HA, Alaloola A, et al. Development and evaluation of a school‐based asthma educational program. Journal of Asthma 2017;54(4):419‐29. - PubMed
Alreshidi 2015 {published data only}
    1. Alreshidi N. The impact of a school‐based asthma health education programme on quality of life, knowledge and attitudes of Saudi children with asthma. Clinical and Experimental Allergy 2015;45(2):514.
Al‐Sheyab 2015 {published data only}
    1. Al‐Sheyab N, Alomari M, Shah S, Gallagher R. 'Class smoke‐free' pledge impacts on nicotine dependence in male adolescents: a cluster randomized controlled trial. Tropical Medicine and International Health 2015;20:255‐6.
Anderson 2004 {published data only}
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Ando 2016 {published data only}
    1. Ando T, Yamamoto‐Hanada K, Nagao M, Fujisawa T, Ohya Y. Combined program with computer‐based learning and peer education in early adolescents with asthma: a pilot study. Journal of Allergy and Clinical Immunology 2016;137(2):AB157.
Arnold 2012 {published data only}
    1. Arnold RJ, Stingone JA, Claudio L. Computer‐assisted school‐based asthma management: a pilot study. JMIR Research Protocols 2012;1(2):e15. - PMC - PubMed
Arıkan‐Ayyıldız 2016 {published data only}
    1. Arıkan‐Ayyıldız Z, Işık S, Çağlayan‐Sözmen Ş, Ana Ö, Karaman Ö, Uzuner N. Efficacy of asthma education program on asthma control in children with uncontrolled asthma. Turkish Journal of Pediatrics 2016;58(4):383‐8. - PubMed
Augustin 2003 {published data only}
    1. Augustin J. An Intensive Asthma Intervention in a School‐Based Clinic [Dissertation]. Chicago, IL: Rush University, 2003:14p.
Becker 2003 {published data only}
    1. Becker AB, Whitters D, Gillespie CA, Filuk SE, McColm JE, Thomas NJ, et al. Impact of a randomized asthma education program on asthma control in children [Abstract]. Journal of Asthma and Clinical Immunology 2003;111:S212.
Bignall 2015a {published data only}
    1. Bignall WJ, Luberto CM, Cornette AF, Haj‐Hamed M, Cotton S. Breathing retraining for African‐American adolescents with asthma: a pilot study of a school‐based randomized controlled trial. Journal of Asthma 2015;52(9):889‐96. - PubMed
Bollinger 2010 {published data only}
    1. Bollinger ME, Morphew T, Mullins CD. The Breathmobile program: a good investment for underserved children with asthma. Annals of Allergy, Asthma and Immunology 2010;105(4):274‐81.e1. - PubMed
Bowen 2013 {published data only}
    1. Bowen F. Asthma education and health outcomes of children aged 8 to 12 years. Clinical Nursing Research 2013;22(2):172‐85. - PubMed
Brooten 2008 {published data only}
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Bruzzese 2001 {published data only}
    1. Bruzzese JM, Markman LB, Appel D, Webber M. An evaluation of Open Airways for Schools: using college students as instructors. Journal of Asthma 2001;38(4):337‐42. - PubMed
Bruzzese 2006 {published data only}
    1. Bruzzese JM, Evans D, Wiesemann S, Pinkett‐Heller M, Levison MJ, Du Y, et al. Using school staff to establish a preventive network of care to improve elementary school students' control of asthma. Journal of School Health 2006;76(6):307‐12. - PubMed
Bruzzese 2011a {published data only}
    1. Bruzzese JM, Cespedes A, Sheares BJ, Kingston S, Evans D, Sheares BJ. Feasibility and preliminary outcomes of a school‐based approach to helping urban ethnic minority adolescents with undiagnosed asthma. Patient Education and Counseling 2011;85(2):290‐4. - PMC - PubMed
Burgess 2017 {published data only}
    1. Burgess K, Smith B. Efficacy of telemedicine in delivering pediatric asthma education in a rural West Alabama elementary school. Journal of Investigative Medicine 2017;65(2):412‐3.
Burkhart 2003 {published data only}
    1. Burkhart PV, Ward HJ. Children's self‐reports of characteristics of their asthma episodes. Journal of Asthma 2003;40(8):909‐16. - PubMed
Bush 2014 {published data only}
    1. Bush JS, Waller JL, Ownby DR, Tingen MS. Do parents influence health literacy and impact asthma self‐management in rural Georgia high school students?. Annals of Allergy, Asthma and Immunology 2014;113(5 Suppl 1):A20.
Butz 2005 {published data only}
    1. Butz A, Pham L, Lewis L, Lewis C, Hill K, Walker J, et al. Rural children with asthma: impact of a parent and child asthma education program. Journal of Asthma 2005;42(10):813‐21. - PMC - PubMed
    1. Walker J, Winkelstein M, Land C, Lewis‐Boyer L, Quartey R, Pham L, et al. Factors that influence quality of life in rural children with asthma and their parents. Journal of Pediatric Health Care 2008;22(6):343‐50. - PMC - PubMed
Carpenter 2016b {published data only}
    1. Carpenter DM, Geryk LL, Sage A, Arrindell C, Sleath BL. Exploring the theoretical pathways through which asthma app features can promote adolescent self‐management. Translational Behavioral Medicine 2016;6(4):509‐18. - PMC - PubMed
Cheung 2015 {published data only}
    1. Cheung K, Rasberry CN, Dunville RL, Buckley R, Cook D, Daniels B, et al. A multicomponent school‐based asthma management program: enhancing connections to clinical care. Journal of School Health 2015;85(2):135‐40. - PMC - PubMed
Chini 2011 {published data only}
    1. Chini L, Iannini R, Chianca M, Corrente S, Graziani S, Rocca M, et al. Happy Air®, a successful school‐based asthma educational and interventional program for primary school children. Journal of Asthma 2011;48(4):419‐26. - PubMed
Christiansen 1997 {published data only}
    1. Christiansen SC, Martin SB, Schleicher NC, Koziol JA, Mathews KP, Zuraw BL. Evaluation of a school‐based asthma education program for inner‐city children. Journal of Allergy and Clinical Immunology 1997;100(5):613‐7. - PubMed
Clark 1986 {published data only}
    1. Clark NM, Feldman CH, Evans D, Duzey O, Levison MJ, Wasilewski Y, et al. Managing better: children, parents, and asthma. Patient Education and Counseling 1986;8(1):27‐38. - PubMed
Clark 2003 {published data only}
    1. Clark NM. School‐based approaches to help pre‐teens manage asthma. CRISP (Computer Retrieval of Information on Scientific Projects) 2003;31/01/2008 End date:1‐2.
Coté 1997 {published data only}
    1. Coté J, Cartier A, Robichaud P, Boutin H, Malo JL, Rouleau M, et al. Influence on asthma morbidity of asthma education programs based on self‐management plans following treatment optimization. American Journal of Respiratory and Critical Care Medicine 1997;155(5):1509‐14. - PubMed
De Godoi 2016 {published data only}
    1. Molino CG, Romano‐Lieber NS, Ribeiro E, Melo DO. Non‐communicable disease clinical practice guidelines in Brazil: a systematic assessment of methodological quality and transparency. PLoS ONE 2016;11(11):1‐15. - PMC - PubMed
de Greef, 2017 {published data only}
    1. de GreefM, Pijnenburg HM, Hattum MJ, McLeod BD, et al. Parent‐professional alliance and outcomes of child, parent, and family treatment: a systematic review. Journal of Child and Family Studies 2017;26(4):961‐76.
DePue 2007 {published data only}
    1. DePue JD, McQuaid EL, Koinis‐Mitchell D, Camillo C, Alario A, Klein RB. Providence school asthma partnership: school‐based asthma program for inner‐city families. Journal of Asthma 2007;44(6):449‐53. - PubMed
Eakin 2012 {published data only}
    1. Eakin MN, Rand CS, Bilderback A, Bollinger ME, Butz A, Kandasamy V, et al. Asthma in Head Start children: effects of the Breathmobile program and family communication on asthma outcomes. Journal of Allergy and Clinical Immunology 2012;129(3):664‐70. - PMC - PubMed
Evans 2001 {published data only}
    1. Evans D, Clark NM, Levison MJ, Levin B, Mellins RB. Can children teach their parents about asthma?. Health Education and Behavior 2001;28(4):500‐11. - PubMed
Fernandes 2006 {published data only}
    1. Fernandes L, Fonseca JA, Costa‐pereira A, Delgado L, Martins S, Moreira A, et al. Effect on quality of life of multidisciplinary psycho‐educational group interventions: a randomized controlled trial [Abstract]. Journal of Allergy and Clinical Immunology 2006;117:S139.
Francis 2001 {published data only}
    1. Francis C. Setting up a school‐based clinic to improve adolescent asthma. Community Nurse 2001;7(6):19.
Gardida 2002 {published data only}
    1. Gardida A, Rojas M, Tavera C, Catalan M. Evaluation of an educational program to control asthma in school age children in the Morelos state, Mexico. [Spanish]. Revista del Instituto Nacional de Enfermedades Respiratorias 2002;15(1):27‐30.
Gerald 2016 {published data only}
    1. Gerald JK, Gerald LB. The unfulfilled promise of school‐centered asthma care. Journal of Allergy and Clinical Immunology 2016;4(5):980‐1. - PubMed
Gibson 1998 {published data only}
    1. Gibson PG, Shah S, Mamoon HA. Peer‐led asthma education for adolescents: impact evaluation. Journal of Adolescent Health 1998;22(1):66‐72. - PubMed
Grad 2009 {published data only}
    1. Grad R, McClure L, Zhang S, Mangan J, Gibson L, Gerald L. Peak flow measurements in children with asthma: what happens at school?. Journal of Asthma 2009;46(6):535‐40. - PMC - PubMed
Greenberg 2010 {published data only}
    1. Greenberg C, Luna P, Simmons G, Huhman M, Merkle S, Robin L, et al. Follow‐up of an elementary school intervention for asthma management: do gains last into middle school?. Journal of Asthma 2010;47(5):587‐93. - PubMed
Greer 2009 {published data only}
    1. Greer M, Lin L, Atkinson RK. Using a computer game to teach school‐aged children about asthma. Interactive Learning Environments 2017;25(4):431‐8.
    1. Greer MZ. Effect of a CD‐ROM Game to Teach School‐Age Children About Asthma [doctoral thesis]. Tempe, AZ: Arizona State University, 2009.
Gregory 2000 {published data only}
    1. Gregory EK. Empowering students on medication for asthma to be active participants in their care: an exploratory study. Journal of School Nursing 2000;16(1):20‐7. - PubMed
Halterman 2004 {published data only}
    1. Halterman JS, Szilagyi PG, Yoos HL, Conn KM, Kaczorowski JM, Holzhauer RJ, et al. Benefits of a school‐based asthma treatment program in the absence of secondhand smoke exposure: results of a randomized clinical trial. Archives of Pediatrics and Adolescent Medicine 2004;158(5):460‐7. - PubMed
Halterman 2011 {published data only}
    1. Halterman JS, Riekert K, Bayer A, Fagnano M, Tremblay P, Blaakman S, et al. A pilot study to enhance preventive asthma care among urban adolescents with asthma. Journal of Asthma 2011;48(5):523‐30. - PMC - PubMed
Halterman 2011a {published data only}
    1. Blaakman S, Tremblay PJ, Halterman JS, Fagnano M, Borrelli B. Implementation of a community‐based secondhand smoke reduction intervention for caregivers of urban children with asthma: process evaluation, successes and challenges. Health Education Research 2012;28(1):141‐52. - PMC - PubMed
    1. Halterman JS, Szilagyi PG, Fisher SG, Fagnano M, Tremblay P, Conn KM, et al. Randomized controlled trial to improve care for urban children with asthma: results of the school‐based asthma therapy trial. Archives of Pediatrics and Adolescent Medicine 2011;165(3):262‐8. - PMC - PubMed
    1. Noyes K, Bajorska A, Fisher S, Sauer J, Fagnano M, Halterman JS. Cost‐effectiveness of the School‐Based Asthma Therapy (SBAT) program. Pediatrics 2013;131(3):e709‐17. - PMC - PubMed
Halterman 2012 {published data only}
    1. Halterman JS, Fagnano M, Montes G, Fisher S, Tremblay P, Tajon R, et al. The school‐based preventive asthma care trial: results of a pilot study. Journal of Pediatrics 2012;161(6):1109‐176. - PMC - PubMed
    1. Halterman JSS, Sauer J, Fagnano M, Montes G, Fisher S, Tremblay P, et al. Working toward a sustainable system of asthma care: development of the School‐Based Preventive Asthma Care Technology (SB‐PACT) trial. Journal of Asthma 2012;49(4):395‐400. - PMC - PubMed
Hemate 2012 {published data only}
    1. Hemate Z, Ghazavi Z, Hasanpor M, Iranpor R, Alidosti M. An examination of the effect of health promotion plan in high school students' on knowledge and performance on peers suffering from asthma in high schools of district 3 in Esfahan, 2010. Journal of Education and Health Promotion 2012;1:33. - PMC - PubMed
Hill 1991 {published data only}
    1. Hill R, Williams J, Britton J, Tattersfield A. Can morbidity associated with untreated asthma in primary school children be reduced? A controlled intervention study. BMJ 1991;303(6811):1169‐74. - PMC - PubMed
Horner 1998 {published data only}
    1. Horner SD. Using the Open Airways curriculum to improve self‐care for third grade children with asthma. Journal of School Health 1998;68(8):329‐33. - PubMed
Horner 2003 {published data only}
    1. Horner SD. Enhancing children's and parents' asthma management. CRISP (Computer Retrieval of Information on Scientific Projects) 2003;30/04/2007 end date:1.
Hughes {published data only}
    1. Hughes M, Murphy M. Evaluation of a pilot national online asthma E‐learning program for secondary school students*. Issues in Comprehensive Pediatric Nursing 2013;37(2):136‐46. - PubMed
Johnson 2016 {published data only}
    1. Johnson KB, Patterson BL, Ho YX, Chen QX, Nian H, Davison CL, et al. The feasibility of text reminders to improve medication adherence in adolescents with asthma. Journal of the American Medical Informatics Association 2016;23(3):449‐55. - PMC - PubMed
Jones 2005 {published data only}
    1. Jones CA, Clement LT, Hanley‐Lopez J, Morphew T, Kwong KYC, Lifson F, et al. The Breathmobile(trademark) Program: structure, implementation, and evolution of a large‐scale, urban, pediatric asthma disease management program. Disease Management 2005;8(4):205‐22. - PubMed
    1. Jones CA, Clement LT, Morphew T, Kwong KY, Hanley‐Lopez J, Lifson F, et al. Achieving and maintaining asthma control in an urban pediatric disease management program: the Breathmobile Program. Journal of Allergy and Clinical Immunology 2007;119(6):1445‐53. - PubMed
Joseph 2004 {published data only}
    1. Joseph V. A study compliance to two alternative drug regimens and the effect of health education on drug compliance in school age children with bronchial asthma. Nursing Journal of India 2004;95(7):153‐4. - PubMed
Joseph 2007 {published data only}
    1. Joseph CL, Peterson E, Havstad S, Johnson CC, Hoerauf S, Stringer S, et al. A web‐based, tailored asthma management program for urban African‐American high school students. American Journal of Respiratory and Critical Care Medicine 2007;175(9):888‐95. - PMC - PubMed
Joseph 2013a {published data only}
    1. Joseph CL, Ownby DR, Havstad SL, Saltzgaber J, Considine S, Johnson D, et al. Evaluation of a web‐based asthma management intervention program for urban teenagers: reaching the hard to reach. Journal of Adolescent Health 2013;52(4):419‐26. - PMC - PubMed
Kaufman 2011 {published data only}
    1. Kaufman D, Sauve L, Renaud L. Enhancing learning through an online secondary school educational game. Journal of Educational Computing Research 2011;44(4):409‐28.
    1. Kaufman D, Sauve L, Renaud L. The impact of an online educational game on knowledge and attitudes. Proceedings of the 6th International Conference on E‐Learning 2011;44:173‐82.
Kenny 2016 {published data only}
    1. Kenny P, Dunne M. Asthma Friendly School Award ‐ a new way of engaging schools, students and families in asthma management education. Irish Journal of Medical Science 2016;185:S483.
Khan 2014 {published data only}
    1. Khan R, Maharaj R, Seerattan N, Babwah F. Effectiveness of personalized written asthma action plans in the management of children with partly controlled asthma in Trinidad: a randomized controlled trial. Journal of Tropical Pediatrics 2014;60(1):17‐26. - PubMed
Khoshnavay 2013 {published data only}
    1. Khoshnavay F, Kharazmi RA. The effectiveness of rational emotive behavior therapy (REBT) on the quality of life in asthmatic children. Iranian Journal of Allergy, Asthma and Immunology 2013;12(1):S130.
Kintner 2015 {published data only}
    1. Kintner E, Cook G, Marti CN, Stoddard D, Gomes M, Harmon P, et al. Comparative effectiveness on cognitive asthma outcomes of the SHARP Academic Asthma Health Education and Counseling Program and a non‐academic program. Research in Nursing and Health 2015;38(6):423‐35. - PMC - PubMed
    1. Kintner EK, Cook G, Marti CN, Allen A, Stoddard D, Harmon P, et al. Effectiveness of a school‐ and community‐based academic asthma health education program on use of effective asthma self‐care behaviors in older school‐age students. Journal for Specialists in Pediatric Nursing 2015;20(1):62‐75. - PMC - PubMed
Knight 2005 {published data only}
    1. Knight DD. Expanding Asthma Awareness in Adolescents: A Pilot Investigation [dissertation]. Honolulu, HI: University of Hawaii at Manoa, 2005.
Krishna 2006 {published data only}
    1. Krishna S, Balas EA, Francisco BD, Konig P. Effective and sustainable multimedia education for children with asthma: a randomized controlled trial. Children's Health Care 2006;35(1):75‐90.
Lakupoch 2017 {published data only}
    1. Lakupoch K, Manuyakorn W, Preutthipan A, Kamalaporn H. The effectiveness of newly developed written asthma action plan in improvement of asthma outcome in children. Asian Pacific Journal of Allergy and Immunology 2017;1:1‐5. - PubMed
Lewis 2005 {published data only}
    1. Lewis CJ, Thompson RE, Butz AM, Hill KL, Huss K, Lewis‐Bowyer LL, et al. Asthma education increases knowledge of rural parents and children with asthma and affects parents' reports of their child's asthma symptoms [Abstract]. Journal of Allergy and Clinical Immunology 2005;115:S132.
Li 2017 {published data only}
    1. Li Z, Leite WL, Thompson LA, Gross HE, Shenkman EA, Reeve BB, et al. Determinants of longitudinal health‐related quality‐of‐life change in children with asthma from low‐income families: a report from the PROMIS® Pediatric Asthma Study. Clinical and Experimental Allergy 2017;47(3):383‐94. - PMC - PubMed
Liao 2006 {published data only}
    1. Liao O, Morphew T, Amaro S, Galant SP. The Breathmobile: a novel comprehensive school‐based mobile asthma care clinic for urban underprivileged children. Journal of School Health 2006;76(6):313‐9. - PubMed
Lin 2017 {published data only}
    1. Lin CH, Zedeck SS, Garcia Lloret MI. UCLA (Long Beach) Breathmobile: improving asthma outcomes in low‐income pediatric patients. Journal of Allergy and Clinical Immunology 2017;139(2):AB99.
Lipman 2017 {published data only}
    1. Lipman TH. Using tailored videos to teach inhaler technique to children with asthma: results from a school nurse‐led pilot study. MCN. The American Journal of Maternal Child Nursing 2017;42(3):185. - PubMed
Loman 2017 {published data only}
    1. Loman DG, Kwong CG, Henry LD, Mahl C, Meadows L, Ellis AG. Asthma control and obesity in urban African American children. Journal of Asthma 2017;54(6):578‐83. - PubMed
Louisias 2016 {published data only}
    1. Louisias M, Goldmann D, Phipatanakul W. School nurses' perspectives on barriers to implementing school‐based asthma management plans. Journal of Allergy and Clinical Immunology 2016;137(2):AB100.
Lu 2017 {published data only}
    1. Lu KD, Cooper D, Haddad F, Lakes KD, Radom‐Aizik S. Four months of a school based exercise intervention improved fitness in normal weight and overweight/obese children with asthma in a minority, low SES population ‐ a pilot study. American Journal of Respiratory and Critical Care Medicine 2017;195:1.
Lurie 2001 {published data only}
    1. Lurie N, Bauer EJ, Brady C. Asthma outcomes at an inner‐city school‐based health center. Journal of School Health 2001;71(1):9‐16. - PubMed
Lwebuga‐Mukasa 2002 {published data only}
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Maa 2010 {published data only}
    1. Maa SH, Chang YC, Chou CL, Ho SC, Sheng TF, MacDonald K, et al. Evaluation of the feasibility of a school‐based asthma management programme in Taiwan. Journal of Clinical Nursing 2010;19(17‐18):2415‐23. - PubMed
MacPherson 2011 {published data only}
    1. MacPherson A, Snider C, Kakepetum‐Schults T, McGhan S. Growing healthy children and youth: an asthma education program. Canadian Respiratory Journal 2011;18:26A.
Mangan 2006 {published data only}
    1. Mangan JMM, Gerald LBB. Asthma agents: monitoring asthma in school. Journal of School Health 2006;76(6):300‐2. - PubMed
Marabini 2002 {published data only}
    1. Marabini A, Brugnami G, Curradi F, Casciola G, Stopponi R, Pettinari L, et al. Short‐term effectiveness of an asthma educational program: results of a randomized controlled trial. Respiratory Medicine 2002;96(12):993‐8. - PubMed
McClure 2008 {published data only}
    1. McClure LA, Harrington KF, Graham H, Gerald LB. Internet‐based monitoring of asthma symptoms, peak flow meter readings, and absence data in a school‐based clinical trial. Clinical Trials 2008;5(1):31‐7. - PMC - PubMed
McElmurry 1999 {published data only}
    1. McElmurry BJ, Buseh AG, Dublin M. Health education program to control asthma in multiethnic, low‐income urban communities: the Chicago Health Corps Asthma Program. Chest 1999;116(4 Suppl 1):198S‐9S. - PubMed
McEwen 1998 {published data only}
    1. McEwen M, Johnson P, Neatherlin J, Millard MW, Lawrence G. School‐based management of chronic asthma among inner‐city African‐American schoolchildren in Dallas, Texas. Journal of School Health 1998;68(5):196‐201. - PubMed
McLaughlin 2006 {published data only}
    1. McLaughlin T, Maljanian R, Kornblum R, Clark P, Simpson J, McCormack K. Evaluating the availability and use of asthma action plans for school‐based asthma care: a case study in Hartford, Connecticut. Journal of School Health 2006;76(6):325‐8. - PubMed
Meng 2000 {published data only}
    1. Meng A. A school‐based asthma clinic: a partnership model for managing childhood asthma. Nurse Practitioner Forum ‐ Current Topics and Communications 2000;11(1):38‐47. - PubMed
Meurer 1999 {published data only}
    1. Meurer JR, McKenzie S, Mischler E, Subichin S, Malloy M, George V. The Awesome Asthma School Days program: educating children, inspiring a community. Journal of School Health 1999;69(2):63‐8. - PubMed
Millard 2003 {published data only}
    1. Millard MW, Johnson PT, McEwen M, Neatherlin J, Lawrence G, Kennerly DK, et al. A randomized controlled trial using the school for anti‐inflammatory therapy in asthma. Journal of Asthma 2003;40(7):769‐76. - PubMed
Mitchell 2017 {published data only}
    1. Mitchell DK, McQuaid EL, Fritz GK, Kopel SJ, Seifer R, Esteban CA, et al. Culturally and contextually tailored asthma self‐management for urban, Latino middle school students: the Rhode Island‐Puerto Rico Asmas program. American Journal of Respiratory and Critical Care Medicine 2017;195:1.
Morphew 2013 {published data only}
    1. Morphew T, Scott L, Li M, Galant SP, Wong W, Lloret Maria IG, et al. Mobile health care operations and return on investment in predominantly underserved children with asthma: the Breathmobile Program. Population Health Management 2013;16(4):261‐9. - PubMed
    1. Xi SC, Morphew T, Kwong K, Li M, Thobani S, Nichols B, et al. Association between obesity and asthma control in children: the Breathmobile Program. Annals of Allergy, Asthma and Immunology 2015;115(5):A23.
Morphew 2017 {published data only}
    1. Morphew T, Altamirano W, Bassin SL, Galant SP. The Breathmobile improves the asthma medication ratio and decreases emergency department utilization. American Journal of Managed Care 2017;23(4):120‐6. - PubMed
Morton 2017 {published data only}
    1. Morton RW, Elphick HE, Rigby AS, Daw WJ, King DA, Smith LJ, et al. STAAR: a randomised controlled trial of electronic adherence monitoring with reminder alarms and feedback to improve clinical outcomes for children with asthma. Thorax 2017;72(4):347‐54. - PubMed
Mosnaim 2017 {published data only}
    1. Mosnaim GS, Akkoyun E, Eng J, Shalowitz MU. Behavioral interventions to improve asthma outcomes: a systematic review of recent publications. Current Opinion in Allergy and Clinical Immunology 2017;17(3):194‐200. - PubMed
NCT00217776 {published data only}
    1. NCT00217776. School‐based approaches to help pre‐teens manage asthma. clinicaltrials.gov/ct2/show/NCT00217776 (first received 22 September 2005).
Neuharth‐Pritchett 2016 {published data only}
    1. Neuharth‐Pritchett S, Getch YQ. The effectiveness of a brief asthma education intervention for child care providers and primary school teachers. Early Childhood Education Journal 2016;44(6):555‐61.
Nuss 2016 {published data only}
    1. Nuss HJ, Hester LL, Perry MA, Stewart‐Briley C, Reagon VM, Collins P. Applying the social ecological model to creating asthma‐friendly schools in Louisiana. Journal of School Health 2016;86(3):225‐32. - PMC - PubMed
Otim 2015 {published data only}
    1. Otim ME, Jayasinha R, Forbes H, Smita S. Building evidence for peer‐led interventions: assessing the cost of the Adolescent Asthma Action program in Australia. Australian Journal of Primary Health 2015;21(4):438‐43. - PubMed
Patel 2007 {published data only}
    1. Patel B, Sheridan P, Detjen P, Donnersberger D, Gluck E, Malamut K, et al. Success of a comprehensive school‐based asthma intervention on clinical markers and resource utilization for inner‐city children with asthma in Chicago: the Mobile C.A.R.E. Foundation's asthma management program. Journal of Asthma 2007;44(2):113‐8. - PubMed
Peers 2017 {published data only}
    1. Peers CB, Mullan A, Chodhari R. Asthma innovation research ‐ air. Archives of Disease in Childhood 2017;102:A168.
Pender‐Phaneuf 2016 {published data only}
    1. Pender‐Phaneuf K. Pediatric asthma management in Massachusetts schools: facilitators and barriers. Nursing Research 2016;65(2):E31‐2.
Perry 2000 {published data only}
    1. Perry CS, Toole KA. Impact of school nurse case management on asthma control in school‐aged children. Journal of School Health 2000;70(7):303‐4. - PubMed
Petrie 2010 {published data only}
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Quaranta 2012 {published data only}
    1. Quaranta J, Brown K, Logvis K, Ponticiello D. Using nursing students as open airways facilitators through a community partnership to influence asthma outcomes. Journal of Asthma and Allergy Educators 2012;3(2):56‐63.
Quaranta 2015 {published data only}
    1. Quaranta JE, Spencer GA. Using the health belief model to understand school nurse asthma management. Journal of School Nursing 2015;31(6):430‐40. - PubMed
Rasberry 2014 {published data only}
    1. Rasberry CN, Cheung K, Buckley R, Dunville R, Daniels B, Cook D, et al. Indicators of asthma control among students in a rural, school‐based asthma management program. Journal of Asthma 2014;51(8):876‐85. - PMC - PubMed
Raun 2017 {published data only}
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Rhee 2012 {published data only}
    1. Rhee H, Pesis‐Katz I, Xing JP. Cost benefits of a peer‐led asthma self‐management program for adolescents. Journal of Asthma 2012;49(6):606‐13. - PMC - PubMed
Richterová 2016 {published data only}
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Rodriguez‐Martinez 2017 {published data only}
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Sabla 2017 {published data only}
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Salisbury 2002 {published data only}
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Schlueter 2011 {published data only}
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Schneider 1997 {published data only}
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Scott 2006 {published data only}
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Scott 2008 {published data only}
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Scott 2011 {published data only}
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Shanovich 2009 {published data only}
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Sharek 2002 {published data only}
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Shaw 2005 {published data only}
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Shaw 2016 {published data only}
    1. Shaw N, Souëf P, Turkovic L, McCahon L, Kicic A, Sly PD. Pressurised metered dose inhaler‐spacer technique in young children improves with video instruction. European Journal of Pediatrics 2016;175(7):1007‐12. - PubMed
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Tate 2009 {published data only}
    1. Tate ED. Asthma in the Community: Designing Instruction to Help Students Explore Scientific Dilemmas That Impact Their Lives [thesis]. Berkeley, CA: University of California, 2009.
Terpstra 2012a {published data only}
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Walter 2016 {published data only}
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References to studies awaiting assessment

Liptzin 2016a {published data only}
    1. Liptzin DR, Gleason MC, Cicutto LC, Cleveland CL, Shocks DJ, White MK, et al. Developing, implementing, and evaluating a school‐centered asthma program: step‐up asthma program. Journal of Allergy and Clinical Immunology 2016;4(5):972‐99.e1. - PubMed
McCallum 2017 {published data only}
    1. McCallum GB, Chang AB, Wilson CA, Petsky HL, Saunders J, Pizzutto SJ, et al. Feasibility of a peer‐led asthma and smoking prevention project in Australian schools with high indigenous youth. Frontiers in Pediatrics 2017;5:33. - PMC - PubMed
Praena‐Crespo 2017 {published data only}
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Warren 2016 {published data only}
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References to ongoing studies

Halterman 2017 {published data only}
    1. Halterman JS, Tajon R, Tremblay P, Fagnano M, Butz A, Perry TT, et al. Development of school‐based asthma management programs in Rochester, New York: presented in honor of Dr Robert Haggerty. Academic Pediatrics 2017;17(6):595‐9. - PMC - PubMed
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NCT03032744 {published data only}
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Perry 2015 {published data only}
    1. Perry TT, Halterman JS, Brown RH, Hunter CR, Randle SM, Tilford JM, et al. Breath Connection: a school‐based telemedicine program for rural children with asthma. Journal of Allergy and Clinical Immunology 2015;135(2 Suppl 1):Abs169.
Phipatanakul 2017 {published data only}
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