Self-management education and regular practitioner review for adults with asthma

BACKGROUND: A key component of many asthma management guidelines is the recommendation for patient education and regular medical review. A number of controlled trials have been conducted to measure the effectiveness of asthma education programmes. These programmes improve patient knowledge, but their impact on health outcomes is less well established. This review was conducted to examine the strength of evidence supporting Step 6 of the Australian Asthma Management Plan: "Educate and Review Regularly"; to test whether health outcomes are influenced by education and self-management programmes. OBJECTIVES: The objective of this review was to assess the effects of asthma self-management programmes, when coupled with regular health practitioner review, on health outcomes in adults with asthma. SEARCH STRATEGY: We searched the Cochrane Airways Group trials register and reference lists of articles. SELECTION CRITERIA: Randomised trials of self-management education in adults over 16 years of age with asthma. DATA COLLECTION AND ANALYSIS: Trial quality was assessed and data were extracted independently by two reviewers. Study authors were contacted for confirmation. MAIN RESULTS: Thirty six trials, which compared self-management education with usual care, were included. Self-management education reduced hospitalisations (relative risk 0.64, 95% confidence interval 0.50 to 0.82); emergency room visits (relative risk 0.82, 95% confidence interval (0.73 to 0.94); unscheduled visits to the doctor (relative risk 0.68, 95% confidence interval 0.56 to 0.81); days off work or school (relative risk 0.79, 95% confidence interval 0.67 to 0.93); nocturnal asthma (relative risk 0.67, 95% confidence interval 0.0.56 to 0.79); and quality of life (standard mean difference 0.29, confidence interval 0.11 to 0.47). Measures of lung function were little changed. REVIEWER'S CONCLUSIONS: Education in asthma self-management which involves self-monitoring by either peak expiratory flow or symptoms, coupled with regular medical review and a written action plan improves health outcomes for adults with asthma. Training programmes that enable people to adjust their medication using a written action plan appear to be more effective than other forms of asthma self-management.