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

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Abstract
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 methods 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 Two reviewers assessed trial quality and extracted data independently. We contacted study authors for confirmation. Main results We included thirty six trials, which compared self‐management education with usual care. Self‐management education reduced hospitalisations (relative risk (RR) 0.64, 95% confidence interval (CI) 0.50 to 0.82); emergency room visits (RR 0.82, 95% CI 0.73 to 0.94); unscheduled visits to the doctor (RR 0.68, 95% CI 0.56 to 0.81); days off work or school (RR 0.79, 95% CI 0.67 to 0.93); nocturnal asthma (RR 0.67, 95% CI 0.0.56 to 0.79); and quality of life (standard mean difference 0.29,CI 0.11 to 0.47). Measures of lung function were little changed. Authors' 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.