Community-based interventions for childhood asthma using comprehensive approaches: a systematic review and meta-analysis

Abstract

Objective: We conducted a systematic review and meta-analysis to determine the effectiveness of comprehensive community-based interventions with ≥ 2 components in improving asthma outcomes in children.

Methods: A systematic search of Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica Database (EMBASE), Cochrane Library and hand search of reference collections were conducted to identify any research articles published in English between 2000 and 2019. All studies reporting community-based asthma interventions with ≥ 2 components (e.g., asthma self-management education, home environmental assessment or care coordination etc.) for children aged ≤ 18 years were included. Meta-analyses were performed using random-effects model to estimate pooled odds ratio (OR) with 95% confidence intervals (CIs).

Results: Of the 2352 studies identified, 21 studies were included in the final analysis: 19 pre-post interventions, one randomised controlled trial (RCT) and one retrospective study. Comprehensive asthma programs with multicomponent interventions were associated with significant reduction in asthma-related Emergency Department (ED) visits (OR = 0.26; 95% CI 0.20-0.35), hospitalizations (OR = 0.24; 95% CI 0.15-0.38), number of days (mean difference = - 2.58; 95% CI - 3.00 to - 2.17) and nights with asthma symptoms (mean difference = - 2.14; 95% CI - 2.94 to - 1.34), use of short-acting asthma medications/bronchodilators (BD) (OR = 0.28; 95% CI 0.16-0.51), and increase use of asthma action plan (AAP) (OR = 8.87; 95% CI 3.85-20.45).

Conclusion: Community-based asthma care using more comprehensive approaches may improve childhood asthma management and reduce asthma related health care utilization.

Keywords: Asthma; Childhood; Community-based; Comprehensive intervention; Meta-analysis.

Fig. 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. Footnote: CINAHL Cumulative index to nursing and allied health literature; EMBASE Excerpta Medica Databases

Fig. 2

Summary of risk of bias of included studies. Legends: 1 = Bias due to confounding. 2 = Bias in selection of participants into the study. 3 = Bias in classification of interventions. 4 = Bias due to deviations from intended interventions. 5 = Bias due to missing data. 6 = Bias in measurement of outcomes. 7 = Bias in selection of the reported result

Fig. 3

Pooled odds ratio (OR) of asthma-related ED visits in children with vs without community-based intervention

Fig. 4

Pooled odds ratio of hospitalizations in children with vs without community-based intervention

Fig. 5

Pooled estimates of mean difference for days with asthma symptoms in children with vs without community-based intervention

Fig. 6

Pooled estimates of mean difference for nights with asthma symptoms in children with vs without community-based intervention

Fig. 7

Pooled odds ratio (OR) of short-acting asthma medication/bronchodilator (BD) uses in children with vs without community-based intervention

Fig. 8

Pooled odds ratio (OR) of asthma action plan (AAP) uses in children with vs without community-based intervention