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Effectiveness of school-based self-management interventions for asthma among children and adolescents: findings from a Cochrane systematic review and meta-analysis

Thorax 2019;0:1–7

In England, one in six children between the ages of five and 14 will have experienced asthma at some point, with an estimated 2.8 million school days lost in the UK each year.

It is known that well-controlled asthma is defined by reduced daytime and night-time symptoms and diminished risk of life-threatening asthma attacks. Self-management is a cornerstone of treatment for people with asthma and involves educating and enabling individuals to achieve good control of their asthma symptoms and prevention of future exacerbations.

The impact of providing self-management education and support within schools is unclear, and the aim of this systematic review was to identify and synthesise evidence on school-based interventions for children with asthma, with a focus on effectiveness. There were two key objectives: to identify the key design features and processes associated with successful implementation of school-based asthma self-management interventions; and to understand whether school-based interventions can effectively change asthma self-management behaviour.

Intervention studies were eligible for inclusion in the systematic review if they employed a randomised parallel-group design and were published in English from 1995 onwards. Participants included children aged five to 18 years, who participated within their own school environment. Searches were conducted on the Cochrane Airways Group Specialised Register. The titles and abstracts of 379 outcome evaluation studies were independently screened by two review authors and, following exclusion on title and abstract, 105 full-text records were assessed for eligibility, and 33 outcome evaluation studies were included for further analysis.

School-based interventions were effective in reducing the frequency of emergency department visits and moderately effective in reducing levels of hospitalisations. A meta-analysis of three studies suggest that the approach could reduce the number of days of restricted activity. There is uncertainty as to whether school-based self-management interventions reduce absences from school.

School-based self-management interventions are effective in improving outcomes for children with asthma.

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