Table A Characteristics of included trials

Table B Methodological quality of included trials

Table A Characteristics of included trials

Trial Trial design No of patients (% followed up) Mean age (range) Asthma severity Session type No of sessions Basis of self management strategy Educational strategy Duration of intervention (months)

Alexander 1988^w1 Randomised controlled trial 21 (100) Not reported (2-13) Moderate-severe Individual 4 Symptoms Prevention, attacks 12

Carswell 1989^w2 Randomised controlled trial 86 (100) 11.2 (5-15) Mild-moderate Individual ³1 Peak flow Prevention, attacks 6

Charlton 1994^w3 Randomised controlled trial 91 (87) 6.5 (3-16) Unclear Individual 1 Peak flow Prevention, attacks 1

Christiansen 1997^w4 Controlled clinical trial 50 (84) 10.4 (9-12) Moderate-severe Group 5 Peak flow Prevention, attacks 1

Clark 1986^w5 Randomised controlled trial 308 (83) 9.2 (4-17) Unclear Group 6 Symptoms Prevention, attacks, social skills 6

Colland 1993^w6 Randomised controlled trial 112 (100) 10 (8-12) Unclear Group 10 Symptoms Prevention, attacks, social skills 2.5

Dahl 1990^w7 Randomised controlled trial 20 (95) 12.2 (not reported) Moderate-severe Individual 4 Peak flow Prevention, attacks, social skills 1

Deaves 1993^w8 Controlled clinical trial 64 (98) Not reported (3-16) Moderate-severe Individual 1 Peak flow Prevention, attacks 1

Evans 1987^w9 Randomised controlled trial 239 (85) 9.1 (8-11) Mild-moderate Group 6 Symptoms Prevention, attacks, social skills 1

Fireman 1981^w10 Controlled clinical trial 26 (100) 7.4 (2-14) Moderate-severe Individual and group 6 Symptoms Prevention, attacks, social skills 12

Hill 1991^w11 Randomised controlled trial 451 (66) Not reported (5-10) Moderate-severe Individual and group ³1 Symptoms Attacks 12

Holzheimer 1998^w12 Randomised controlled trial 80 (70) 4.5 (2-6) Unclear Group 3 Symptoms Prevention, attacks 4

Hughes 1991^w13 Randomised controlled trial 95 (94) 9.7 (6-16) Moderate-severe Individual 6 Peak flow Prevention, attacks 12

Kubly 1984^w14 Randomised controlled trial 65 (43) 8.2 (not reported) Unclear Group 3-4 Symptoms Prevention, attacks 1

LeBaron 1985^w15 Randomised controlled trial 31 (100) 10.6 (6-17) Mild-moderate Individual 3 Peak flow Prevention 5

Lewis 1984^w16 Randomised controlled trial 88 (86) 10.3 (7-12) Moderate-severe Group 5 Symptoms Prevention, attacks, social skills 1

Madge 1997^w17 Randomised controlled trial 201 (100) Not reported (2-15) Unclear Individual 3 Peak flow Prevention, attacks, social skills 1

McNabb 1985^w18 Randomised controlled trial 16 (94) 10.4 (9-13) Unclear Individual 5 Symptoms Prevention, attacks 1

Mitchell 1986^w19 Randomised controlled trial 368 (70) 5.9 (2-14) Unclear Individual 6 Symptoms Prevention, attacks 6

Parcel 1980^w20 Controlled clinical trial 104 (100) 7.7 (5-11) Unclear Group 24 Symptoms Prevention, attacks, social skills 6

Perrin 1992^w21 Randomised controlled trial 81 (69) 9.3 (6-14) Moderate-severe Group 4 Symptoms Prevention, attacks 1

Persaud 1996^w22 Randomised controlled trial 36 (100) 10.2 (8-12) Moderate-severe Individual 8 Peak flow Prevention, attacks, social skills 2

Rakos 1985^w23 Randomised controlled trial 43 (100) Not reported (7-12) Moderate-severe Individual 1 Symptoms Prevention, attacks, social skills Unclear

Ronchetti 1997^w24 Randomised controlled trial 312 (67) 9.6 (6-14) Moderate-severe Group 4-8 Symptoms Prevention, attacks, social skills 1-2

Rubin 1986^w25 Randomised controlled trial 65 (83) 9.7 (7-12) Moderate-severe Individual 6 Symptoms Prevention, attacks 10

Shields 1990^w26 Randomised controlled trial 253 (81) 8.8 (<19) Unclear Individual and group 8 Symptoms Prevention, attacks 1-2

Szczepanski1996^w27 Controlled clinical trial 84 (89) Not reported (not reported) Unclear Group ³11 Peak flow Prevention, attacks 6

Talabere 1993^w28 Randomised controlled trial 50 (100) Not reported (8-12) Unclear Individual 2 Symptoms Prevention, attacks, social skills 1

Toelle 1993^w29 Controlled clinical trial 132 (91) 9.2 (8-11) Mild-moderate Group 2 Peak flow Prevention, attacks 1

Weingarten 1985^w30 Randomised controlled trial 20 (95) Not reported (8-11) Unclear Group 26 Peak flow Prevention, attacks, social skills 2.5

Whitman 1985^w31 Randomised controlled trial 38 (100) 8.4 (6-14) Moderate-severe Group 8 Symptoms Prevention, attacks 1

Wilson 1996^w32 Randomised controlled trial 76 (84) 3.8 (not reported) Moderate-severe Group 4 Peak flow Prevention, attacks, social skills 1

Table B Methodological quality of included trials

Trial Allocation concealment* Systematic differences

Care provided Follow up Outcome assessment

Alexander 1988^w1 Unclear Yes No No

Carswell 1989^w2 Adequate No No No

Charlton 1994^w3 Adequate Yes No No

Christiansen 1997^w4 Inadequate No No No

Clark 1986^w5 Unclear No No No

Colland 1993^w6 Unclear No No No

Dahl 1990^w7 Unclear No No No

Deaves 1993^w8 Inadequate No No No

Evans 1987^w9 Adequate No No No

Fireman 1981^w10 Inadequate No No No

Hill 1991^w11 Unclear Yes Yes No

Holzheimer 1998^w12 Unclear No Yes No

Hughes 1991^w13 Adequate Yes No No

Kubly 1984^w14 Adequate No Yes No

LeBaron 1985^w15 Unclear No No No

Lewis 1984^w16 Adequate No No No

Madge 1997^w17 Adequate No No No

McNabb 1985^w18 Adequate No No No

Mitchell 1986^w19 Unclear No Yes No

Parcel 1980^w20 Inadequate No No No

Perrin 1992^w21 Unclear No Yes No

Persaud 1996^w22 Adequate No No No

Rakos 1985^w23 Unclear No No No

Ronchetti 1997^w24 Unclear No Yes No

Rubin 1986^w25 Adequate No Yes No

Shields 1990^w26 Adequate No No No

Szczepanski 1996^w27 Inadequate Yes Yes No

Talabere 1993^w28 Unclear No No No

Toelle 1993^w29 Inadequate Yes No No

Weingarten 1985^w30 Unclear No No No

Whitman 1985^w31 Unclear No No No

Wilson 1996^w32 Adequate No No No

*Whether allocation to treatment or control group was sufficiently concealed before enrolment.

References

w1 Alexander JS, Younger RE, Cohen RM, Crawford LV. Effectiveness of a nurse-managed program for children with chronic asthma. J Pediatr Nurs 1988;3:312-7.

w2 Carswell F, Robinson EJ, Hek G, Shenton T. A Bristol experience: benefits and cost of an "asthma nurse" visiting the homes of asthmatic children. Bristol Med Chir J 1989;104:11-2.

w3 Charlton I, Antoniou AG, Atkinson J, Campbell MJ, Chapman E, Mackintosh T, et al. Asthma at the interface: bridging the gap between general practice and a district general hospital. Arch Dis Child 1994;70:313-8.

w4 Christiansen SC, Martin SB, Schleicher NC, Koziol JA, Mathews KP, Zuraw BL. Evaluation of a school-based asthma education program for inner-city children. J Allergy Clin Immunol 1997;100:613-7.

w5 Clark NM, Feldman CH, Evans D, Levison MJ, Wasilewski Y, Mellins RB. The impact of health education on frequency and cost of health care use by low income children with asthma. J Allergy Clin Immunol 1986;78:108-15.

w6 Colland VT. Learning to cope with asthma: a behavioural self-management program for children. Patient Educ Couns 1993;22:141-52.

w7 Dahl J, Gustafsson D, Melin L. Effects of a behavioral treatment program on children with asthma. J Asthma 1990;27:41-6.

w8 Deaves DM. An assessment of the value of health education in the prevention of childhood asthma. J Adv Nurs 1993;18:354-63.

w9 Evans D, Clark NM, Feldman CH, Rips J, Kaplan D, Levison MJ, et al. A school health education program for children with asthma aged 8-11 years. Health Educ Q 1987;14:267-79.

w10 Fireman P, Friday GA, Gira C, Vierthaler WA, Michaels L. Teaching self-management skills to asthmatic children and their parents in an ambulatory care setting. Pediatrics 1981;68:341-8.

w11 Hill R, Williams J, Britton J, Tattersfield A. Can morbidity associated with untreated asthma in primary school children be reduced?: a controlled intervention study. BMJ 1991;303:1169-74.

w12 Holzheimer L, Mohay H, Masters IB. Educating young children about asthma: comparing the effectiveness of a developmentally appropriate asthma education videotape and picture book. Child Care Health Dev 1998;24:85-99.

w13 Hughes DM, McLeod M, Garner B, Goldbloom RB. Controlled trial of a home and ambulatory program for asthmatic children. Pediatrics 1991;87:54-61.

w14 Kubly LS, McClellan MS. Effects of self-care instruction on asthmatic children. Issues Compr Pediatr Nurs 1984;7:121-30.

w15 LeBaron S, Zeltzer LK, Ratner P, Kniker WT. A controlled study of education for improving compliance with cromolyn sodium (Intal): the importance of physician-patient communication. Ann Allergy 1985;55:811-8.

w16 Lewis CE, Rachelefsky G, Lewis MA, De la Sota A, Kaplan M. A randomized trial of A.C.T. (asthma care training) for kids. Pediatrics 1984;74:478-86.

w17 Madge P, McColl J, Paton J. Impact of nurse-led home management training programme in children admitted to hospital with acute asthma: a randomised controlled study. Thorax 1997;52:223-8.

w18 McNabb WL, Wilson-Pessano SR, Hughes GW, Scamagas P. Self-management education of children with asthma: air wise. Am J Public Health 1985;75:1219-20.

w19 Mitchell EA, Ferguson V, Norwood M. Asthma education by community child health nurses. Arch Dis Child 1986;61:1184-9.

w20 Parcel GS, Nader PR, Tiernan K. A health education program for children with asthma. J Dev Behav Pediatr 1980;1:128-32.

w21 Perrin JM, MacLean WE, Gortmaker SL, Asher KN. Improving the psychological status of children with asthma: a randomized controlled trial. J Dev Behav Pediatr 1992;13:241-7.

w22 Persaud DI, Barnett SE, Weller SC, Baldwin CD, Niebuhr V, McCormick DP. An asthma self-management program for children, including instruction in peak flow monitoring by school nurses. J Asthma 1996;33:37-43.

w23 Rakos RF, Grodek MV, Mack KK. The impact of a self-administered behavioral intervention program on pediatric asthma. J Psychosom Res 1985;29:101-8.

w24 Ronchetti R, Indinnimeo L, Bonci E, Corrias A, Evans D, Hindi-Alexander M, et al. Asthma self-management programmes in a population of Italian children: a multicentric study. Eur Respir J 1997;10:1248-53.

w25 Rubin DH, Leventhal JM, Sadock RT, Letovsky E, Schottland P, Clemente I, et al. Educational intervention by computer in childhood asthma: a randomized clinical trial testing the use of a new teaching intervention in childhood asthma. Pediatrics 1986;77:1-10.

w26 Shields MC, Griffin KW, McNabb WL. The effect of a patient education program on emergency room use for inner-city children with asthma. Am J Public Health 1990;80:36-8.

w27 Szczepanski R, Gebert N, Hummelink R, Konning J, Schmidt S, Runde B, et al. Ergebnis einer strukturlerten asthmaschulung im kindesund jugendalter (Outcome of structured asthma education in childhood and adolescence.) Pneumologie 1996;50:544-8. [In German.]

w28 Talabere LR. The effects of an asthma education program on selected health behaviors of school-aged children with asthma. In: Funk SG, ed. Key aspects of caring for the chronically ill: hospital and home. New York: Springer, 1993:319-30.

w29 Toelle BG, Peat JK, Salome CM, Mellis CM, Bauman AE, Woolcock AJ. Evaluation of a community-based asthma management program in a population sample of school children. Med J Aust 1993;158:742-6.

w30 Weingarten MA, Goldberg J, Teperberg Y. A pilot study of the multidisciplinary management of childhood asthma in a family practice. J Asthma 1985;22:261-5.

w31 Whitman N, West D, Brough FK, Welch M. A study of a self-care rehabilitation program in pediatric asthma. Health Educ Q 1985;12:333-42.

w32 Wilson SR, Latini D, Starr NJ, Fish L, Loes LM, Page A, et al. Education of parents of infants and very young children with asthma: a development evaluation of the Wee Wheezers program. J Asthma 1996;33:239-54.

This Article

Services

Email this article to a friend

What's new

Latest blogs

Find BMJ on:

Services

Tools

Email to friend

Print this page

Online poll

Find out more>>

Resources

Rapid responses for this article

There are no rapid responses for this article.

Print issues

Trial	Trial design	No of patients (% followed up)	Mean age (range)	Asthma severity	Session type	No of sessions	Basis of self management strategy	Educational strategy	Duration of intervention (months)
Alexander 1988^w1	Randomised controlled trial	21 (100)	Not reported (2-13)	Moderate-severe	Individual	4	Symptoms	Prevention, attacks	12
Carswell 1989^w2	Randomised controlled trial	86 (100)	11.2 (5-15)	Mild-moderate	Individual	³1	Peak flow	Prevention, attacks	6
Charlton 1994^w3	Randomised controlled trial	91 (87)	6.5 (3-16)	Unclear	Individual	1	Peak flow	Prevention, attacks	1
Christiansen 1997^w4	Controlled clinical trial	50 (84)	10.4 (9-12)	Moderate-severe	Group	5	Peak flow	Prevention, attacks	1
Clark 1986^w5	Randomised controlled trial	308 (83)	9.2 (4-17)	Unclear	Group	6	Symptoms	Prevention, attacks, social skills	6
Colland 1993^w6	Randomised controlled trial	112 (100)	10 (8-12)	Unclear	Group	10	Symptoms	Prevention, attacks, social skills	2.5
Dahl 1990^w7	Randomised controlled trial	20 (95)	12.2 (not reported)	Moderate-severe	Individual	4	Peak flow	Prevention, attacks, social skills	1
Deaves 1993^w8	Controlled clinical trial	64 (98)	Not reported (3-16)	Moderate-severe	Individual	1	Peak flow	Prevention, attacks	1
Evans 1987^w9	Randomised controlled trial	239 (85)	9.1 (8-11)	Mild-moderate	Group	6	Symptoms	Prevention, attacks, social skills	1
Fireman 1981^w10	Controlled clinical trial	26 (100)	7.4 (2-14)	Moderate-severe	Individual and group	6	Symptoms	Prevention, attacks, social skills	12
Hill 1991^w11	Randomised controlled trial	451 (66)	Not reported (5-10)	Moderate-severe	Individual and group	³1	Symptoms	Attacks	12
Holzheimer 1998^w12	Randomised controlled trial	80 (70)	4.5 (2-6)	Unclear	Group	3	Symptoms	Prevention, attacks	4
Hughes 1991^w13	Randomised controlled trial	95 (94)	9.7 (6-16)	Moderate-severe	Individual	6	Peak flow	Prevention, attacks	12
Kubly 1984^w14	Randomised controlled trial	65 (43)	8.2 (not reported)	Unclear	Group	3-4	Symptoms	Prevention, attacks	1
LeBaron 1985^w15	Randomised controlled trial	31 (100)	10.6 (6-17)	Mild-moderate	Individual	3	Peak flow	Prevention	5
Lewis 1984^w16	Randomised controlled trial	88 (86)	10.3 (7-12)	Moderate-severe	Group	5	Symptoms	Prevention, attacks, social skills	1
Madge 1997^w17	Randomised controlled trial	201 (100)	Not reported (2-15)	Unclear	Individual	3	Peak flow	Prevention, attacks, social skills	1
McNabb 1985^w18	Randomised controlled trial	16 (94)	10.4 (9-13)	Unclear	Individual	5	Symptoms	Prevention, attacks	1
Mitchell 1986^w19	Randomised controlled trial	368 (70)	5.9 (2-14)	Unclear	Individual	6	Symptoms	Prevention, attacks	6
Parcel 1980^w20	Controlled clinical trial	104 (100)	7.7 (5-11)	Unclear	Group	24	Symptoms	Prevention, attacks, social skills	6
Perrin 1992^w21	Randomised controlled trial	81 (69)	9.3 (6-14)	Moderate-severe	Group	4	Symptoms	Prevention, attacks	1
Persaud 1996^w22	Randomised controlled trial	36 (100)	10.2 (8-12)	Moderate-severe	Individual	8	Peak flow	Prevention, attacks, social skills	2
Rakos 1985^w23	Randomised controlled trial	43 (100)	Not reported (7-12)	Moderate-severe	Individual	1	Symptoms	Prevention, attacks, social skills	Unclear
Ronchetti 1997^w24	Randomised controlled trial	312 (67)	9.6 (6-14)	Moderate-severe	Group	4-8	Symptoms	Prevention, attacks, social skills	1-2
Rubin 1986^w25	Randomised controlled trial	65 (83)	9.7 (7-12)	Moderate-severe	Individual	6	Symptoms	Prevention, attacks	10
Shields 1990^w26	Randomised controlled trial	253 (81)	8.8 (<19)	Unclear	Individual and group	8	Symptoms	Prevention, attacks	1-2
Szczepanski1996^w27	Controlled clinical trial	84 (89)	Not reported (not reported)	Unclear	Group	³11	Peak flow	Prevention, attacks	6
Talabere 1993^w28	Randomised controlled trial	50 (100)	Not reported (8-12)	Unclear	Individual	2	Symptoms	Prevention, attacks, social skills	1
Toelle 1993^w29	Controlled clinical trial	132 (91)	9.2 (8-11)	Mild-moderate	Group	2	Peak flow	Prevention, attacks	1
Weingarten 1985^w30	Randomised controlled trial	20 (95)	Not reported (8-11)	Unclear	Group	26	Peak flow	Prevention, attacks, social skills	2.5
Whitman 1985^w31	Randomised controlled trial	38 (100)	8.4 (6-14)	Moderate-severe	Group	8	Symptoms	Prevention, attacks	1
Wilson 1996^w32	Randomised controlled trial	76 (84)	3.8 (not reported)	Moderate-severe	Group	4	Peak flow	Prevention, attacks, social skills	1

Trial	Allocation concealment*	Systematic differences
Trial	Allocation concealment*	Care provided	Follow up	Outcome assessment
Alexander 1988^w1	Unclear	Yes	No	No
Carswell 1989^w2	Adequate	No	No	No
Charlton 1994^w3	Adequate	Yes	No	No
Christiansen 1997^w4	Inadequate	No	No	No
Clark 1986^w5	Unclear	No	No	No
Colland 1993^w6	Unclear	No	No	No
Dahl 1990^w7	Unclear	No	No	No
Deaves 1993^w8	Inadequate	No	No	No
Evans 1987^w9	Adequate	No	No	No
Fireman 1981^w10	Inadequate	No	No	No
Hill 1991^w11	Unclear	Yes	Yes	No
Holzheimer 1998^w12	Unclear	No	Yes	No
Hughes 1991^w13	Adequate	Yes	No	No
Kubly 1984^w14	Adequate	No	Yes	No
LeBaron 1985^w15	Unclear	No	No	No
Lewis 1984^w16	Adequate	No	No	No
Madge 1997^w17	Adequate	No	No	No
McNabb 1985^w18	Adequate	No	No	No
Mitchell 1986^w19	Unclear	No	Yes	No
Parcel 1980^w20	Inadequate	No	No	No
Perrin 1992^w21	Unclear	No	Yes	No
Persaud 1996^w22	Adequate	No	No	No
Rakos 1985^w23	Unclear	No	No	No
Ronchetti 1997^w24	Unclear	No	Yes	No
Rubin 1986^w25	Adequate	No	Yes	No
Shields 1990^w26	Adequate	No	No	No
Szczepanski 1996^w27	Inadequate	Yes	Yes	No
Talabere 1993^w28	Unclear	No	No	No
Toelle 1993^w29	Inadequate	Yes	No	No
Weingarten 1985^w30	Unclear	No	No	No
Whitman 1985^w31	Unclear	No	No	No
Wilson 1996^w32	Adequate	No	No	No