Home-based educational interventions for children with asthma, a Cochrane review

ABSTRACT

Introduction/Aim: Strategies implemented to minimize infection risk from COVID-19, such as social distancing and community lockdowns, means that policy makers, health professionals and asthma patients are considering alternative approaches of service delivery. Home-based asthma education is one approach that may appeal to these groups, and those experiencing socioeconomic disadvantage, where barriers to care such as travel costs can prevent effective management. The efficacy of home-based asthma education to influence health outcomes was last evaluated in a Cochrane systematic review in 2011. Therefore, the aim of this study was to update the evidence to inform policy, clinical care and patient outcomes. Methods: A Cochrane systematic search was undertaken by two-independent researchers using records retrieved from four databases and grey literature (September 2021). Included studies were RCTs of asthma education delivered in the home to children, their caregivers or both. Data extraction, evidence synthesis and reporting of results were conducted in accordance with recommended Cochrane methodology (i.e., Higgins 2021 Cochrane Handbook). Results: Twenty-five studies were included involving 4923 participants predominantly from low socioeconomic and ethnic minority communities. Fourteen studies reported on exacerbations requiring ED visits, with no overall intervention effect. Three studies reported on exacerbations requiring a course of oral corticosteroids (OCS), in which there was a significant reduction in the total number of courses of OCS in the intervention arm compared to the control in one study. Quality of life was reported in eight studies with two able to be meta-analysed (Figure 1), Three reported statistically significant improvements in the intervention arm. Three studies assessed asthma symptom-free days with two producing statistically significant improvements. One showed no evidence of effect. Two studies were metaanalysed identifying no evidence of effect (Figure 2). Conclusion: Substantial diversity across studies/ interventions resulted in an inconsistent evidence base, and the inability to provide meaningful recommendations on home-based education for asthma. (Figure Presented).