Reducing Asthmatic Kids’ Need for Emergency Care

Coffman JM, Cabana MD, Halpin HA, Yelin EH. Effects of asthma education on children's use of acute care services: a meta-analysis. Pediatrics. 2008;121(3):575-586.

Providing asthma education to pediatric patients and their caregivers reduces hospitalizations and emergency department (ED) visits for the condition, according to a meta-analysis by Coffman et al. The researchers suggest that "health plans and medical groups should develop asthma education programs or give clinicians incentives for providing such education."

The data used in this analysis were extracted from 37 articles describing results from studies that enrolled asthmatic patients ages 2 to 17. All studies were conducted in the United States and published in English. Most of the studies (n = 27) compared asthma education with "usual care" (for which definitions varied or were not given); the remainder compared two or more types of interventions.

Pooled estimates from five studies indicated a reduction in the mean number of hospitalizations for patients who received asthma education, compared with those who received usual care (standardized mean difference [SMD], –0.35). Similarly, a reduction in the mean number of ED visits was observed when data from 13 studies were pooled (SMD, –0.17). The likelihood of visiting the ED was lower in patients who received asthma education than in their counterparts, but the odds of hospitalization were similar.

The mean number of urgent physician visits related to asthma was not affected by asthma education. The researchers hypothesize that "children and caregivers who received asthma education may have been more aware of the importance of monitoring symptoms closely and may have promptly sought treatment from children's office-based providers if children experienced symptoms." This care-seeking pattern may in turn have reduced the need for ED visits and/or hospitalizations.

The findings may be limited by the lack of data on the effect of symptom severity or persistence or by the fact that a majority of subjects came from low-income households. Furthermore, the comparisons of different types of interventions yielded conflicting results, although Coffman and colleagues conclude that those that "provide more opportunities for interaction between educators and children or caregivers may be more effective."