School-based interventions improve outcomes in kids with asthma

Reference

Kneale D, Harris K, McDonald VM, Thomas J, Grigg J. Effectiveness of school-based self-management interventions for asthma among children and adolescents: findings from a Cochrane systematic revew and meta-analysis. Thorax 2019;74(5):432-438.

Synopsis

A lot of kids have asthma, and kids spend a lot of time in school, so school-based interventions seem like a sensible idea. This systematic review followed the usual high standards for Cochrane Reviews. The authors identified studies that randomized children individually or in clusters (eg, by schools), were published after 1995, and evaluated interventions that improved knowledge, addressed self-management skills, and/or improved self-management behaviors and practice. They identified 33 studies; most of the studies randomized by school (26) and most took place in the United States or Canada (28). Six studies with 1873 patients demonstrated a smallish but significant reduction in hospitalizations (standardized mean difference [SMD] -0.19; 95% CI -0.35 to -0.04), and 13 studies with 3883 patients demonstrated a significant reduction in emergency department visits (odds ratio 0.70; 0.53 - 0.92). However, there was some heterogeneity for the studies of emergency department visits (I2 = 0.26, where 0 is no heterogeneity and 1.0 is severe heterogeneity). Three studies with 1852 patients found a moderate reduction in days of restricted activity (SMD -0.30; -0.41 to -0.18). These interventions had no effect on absence from school, although there was considerable heterogeneity, with studies based on a theoretical framework finding a reduction in days missed but those without a theoretical framework finding no effect.