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Centre for Evidence-
Based Medicine

Asthma in adults: Self-management education and regular review improves health outcomes.

Clinical Bottom Line

Patients with asthma who receive self-management education are less likely to be admitted to hospital, have fewer visits to the emergency department, fewer unscheduled visits to the doctor, fewer days off work or school, and less nocturnal asthma. Reductions are greater when self-management education includes a written action plan, self-monitoring, and regular medical review.

Citation

Gibson PG, Coughlan J, Wilson AJ et al. Self-management education and regular practitioner review for adults with asthma (Cochrane Review, latest update 25 May 1998). The Cochrane Library. Oxford: Update Software.

Clinical Question

Is a self-management programme that includes asthma education plus regular review by health professionals, effective in improving health outcomes for adults with asthma?

Search Terms

["asthma" OR "wheeze"] AND "patient education" in the Cochrane Library.

The Review

  • Data Sources: MEDLINE, EMBASE, CINAHL; hand searches of respiratory journals and conference abstracts; reference lists of articles.
  • Study Selection: Systematic review of randomised controlled trials (RCTs) and controlled clinical trials (CCTs) that studied the effects of asthma education and self-management on health outcomes of people with asthma who were over 16 years of age. Studies were eligible if they measured any of the following health outcomes: asthma admissions, emergency department visits, unscheduled doctor visits, days off work or school, lung function, peak expiratory flow, use of rescue beta-agonists, use of oral corticosteroids, symptom scores, or quality of life scores.
  • Data Extraction: Data were extracted on study quality, patient and disease characteristics, educational interventions, health outcomes, intermediate outcomes such as knowledge and skills, type of control, and duration of intervention. Interventions were categorised as education, self-monitoring, regular review, written action plan, and optimal self-management.
  • Multiple independent reviews of individual reports? yes
  • Tested for heterogeneity? yes

The Evidence

Outcome CER EER RRR OR (95% CI) ARR NNT (95% CI)
Hospital admissions 0.094 0.053 0.44 0.58 (0.38 to 0.89) 0.041 25 (15-74)
Emergency hospital visits 0.286 0.226 0.21 0.71 (0.57 to 0.9) 0.00 17 (10-58)
Unscheduled doctor visits 0.374 0.276 0.26 0.57 (0.4-0.82) 0.098 11 (7-35)

Comments

See also Gibson PG, Coughlan J, Wilson AJ et al. The effects of limited (information only) education programs on health outcomes of adults with asthma (Cochrane Review, latest version ). In: The Cochrane Library. Oxford: Update Software.

Appraised By

Nicky Cullum, RN, PhD.
Centre for Evidence Based Nursing
University of York, York, UK, YO10 5DQ
Fax: (905) 546-0401
Email: nac2@york.ac.uk
Appraised February 1999.

Expiry Date

2000