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Knowledge is Power العلم نورٌ

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September 01, 2009

Asthma Education May Improve Outcomes of Children With Asthma

Laurie Barclay, MD
August 28, 2009 — Asthma education in a small-group, interactive format may improve outcomes and overall care of children with asthma, according to the results of a randomized controlled trial reported in the August 17 Early Release issue of the Canadian Medical Association Journal.
"Effective approaches to education about asthma need to be identified," write Wade T.A. Watson, MD, MEd, from the University of Manitoba in Winnipeg, Canada, and colleagues. "We evaluated the impact on asthma control by children and their caregivers of an intervention involving small-group, interactive education about asthma."
Children aged 3 to 16 years who visited an emergency department for an asthma exacerbation (n = 398) were randomly assigned to a control or intervention group. In the control group, children received usual care recommended by their primary care physician. In the intervention group, patients participated in a 4-week, small-group, interactive program of education about asthma, in addition to receiving usual medical care.
The asthma care program, which was developed by the Children's Asthma Education Centre, used specific educational materials, personalized mailings to reinforce the program's key points, and age-appropriate pamphlets. An important part of the small-group interaction component was the opportunity for children and their families to discuss successes and failures in managing their child's asthma.
The main endpoint of the study was changes in the number of visits to the emergency department during the year after the intervention.
Compared with children in the control group, those in the intervention group had significantly fewer emergency department visits during the year after enrollment (0.45 vs 0.75 visits per child; P = .004). For children in the intervention group, the likelihood of requiring emergency care was decreased by 38% (relative risk [RR], 0.62; 95% confidence interval [CI], 0.48 - 0.81; P = .004).
Children in the intervention group also received fewer courses of oral corticosteroids (0.63 vs 0.85 per child; P = .006) and had significant improvements in the symptom domain of the questionnaire on pediatric asthma quality of life (P = .03) and in the activity domain of the questionnaire on caregivers' quality of life (P = .05). After participating in the educational program, parents of children in the intervention group also missed less work because of their child's asthma (P = .04). However, there was no apparent effect on hospital admissions.
"Education about asthma, especially in a small-group, interactive format, improved clinically important outcomes and overall care of children with asthma," the study authors write. "We believe that the most important feature of our educational program was the interaction that it fostered between participants in their respective small group settings. In the written feedback we received, parents and children reported that they felt less isolated when dealing with asthma and believed that they benefited from the group-oriented experience."
Limitations of this study include insufficient power to evaluate differences in outcomes between different age groups; enrollment of only 37% of eligible families; and highly motivated participants, limiting generalizability.
In an accompanying commentary, Christopher Cates, BM, BCh, from St. George's University in London, United Kingdom, agrees that recruitment of a small proportion of eligible families may reflect high motivation levels of those enrolled, preventing extrapolation of the findings to less motivated families.
"What matters to children and their families is not so much the general theory behind asthma, but rather how asthma affects them," Dr. Cates writes. "If we are to empower families to prevent visits to the emergency department by improving control of their children's asthma, we need to provide an environment where they can share their stories and air concerns. As doctors, we have a tendency to assume that we know what parents want for their children, and we are often wrong."
Support for this study was provided by Manitoba Health; the Winnipeg Children's Hospital Foundation; and unrestricted educational grants from AstraZeneca, Merck Frosst, and GlaxoSmithKline. The study authors and Dr. Cates have disclosed no relevant financial relationships.
Can Med Assoc J. Published online August 17, 2009

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