Tapp S, Lasserson T J, Rowe B h
Hôpital St-François-D'Assise, Centre de recherche CHUQ, 10, de l'Espinay, Local D1-724D, Quebec City, Quebec, Canada, G1L 3L5.
Cochrane Database Syst Rev. 2007 Jul 18;2007(3):CD003000. doi: 10.1002/14651858.CD003000.pub2.
The use of educational and behavioural interventions in the management of chronic asthma have a strong evidence base. There may be a role for educative interventions following presentation in an emergency setting in adults.
To assess the effectiveness of educational interventions administered following an acute exacerbation of asthma leading to presentation in the emergency department.
We searched the Cochrane Airways Group trials register. Study authors were contacted for additional information. Searches are current to November 2006.
Randomised, parallel group trials were eligible if they recruited adults (> 17 years) who had presented at an emergency department with an acute asthma exacerbation. The intervention of interest was any educational intervention (for example, written asthma management plan).
Two review authors independently assessed trial quality and extracted data. Study authors were contacted for additional information.
Twelve studies involving 1954 adults were included. Education significantly reduced subsequent admission to hospital (relative risk 0.50; 95% confidence interval 0.27 to 0.91); however, did not significantly reduce the risk of re-presentation at emergency departments (ED) the study follow up (relative risk 0.69; 95% confidence interval 0.40 to 1.21). The lack of statistically significant differences between asthma education and control groups in terms of peak flow, quality of life, study withdrawal and days lost were hard to interpret given the low number of studies contributing to these outcomes. One study from the early 1990s measured cost and found no difference for total costs and costs related to physician visits and admissions to hospital. If data were restricted to emergency department treatment, education led to lower costs than control.
AUTHORS' CONCLUSIONS: This review found that educational interventions applied in the emergency department reduce subsequent asthma admissions to hospital. The interventions did not significantly reduce ED re-presentations; while the trend in effect favours educational interventions, the pooled results were not statistically significant. The impact of educational intervention in this context on longer term outcomes relating to asthma morbidity is unclear. Priorities for additional research in this area include assessment of health-related quality of life, lung function assessment, exploration of the relationship between socio-economic status and asthma morbidity, and better description of the intervention assessed.
在慢性哮喘管理中使用教育和行为干预措施有充分的证据基础。在成人急诊就诊后，教育干预可能会发挥作用。
评估在哮喘急性加重导致到急诊科就诊后实施教育干预的效果。
我们检索了Cochrane气道组试验注册库。联系研究作者以获取更多信息。检索截至2006年11月。
如果随机平行组试验招募的是因急性哮喘加重而到急诊科就诊的成年人（>17岁），则符合入选标准。感兴趣的干预措施是任何教育干预（例如，书面哮喘管理计划）。
两位综述作者独立评估试验质量并提取数据。联系研究作者以获取更多信息。
纳入了12项涉及1954名成年人的研究。教育显著降低了随后的住院率（相对危险度0.50；95%置信区间0.27至0.91）；然而，在研究随访期间，并未显著降低再次到急诊科就诊的风险（相对危险度0.69；95%置信区间0.40至1.21）。鉴于对这些结果有贡献的研究数量较少，哮喘教育组和对照组在峰值流量、生活质量、研究退出和误工天数方面缺乏统计学显著差异，难以解释。20世纪90年代初的一项研究测量了成本，发现总成本以及与医生就诊和住院相关的成本没有差异。如果将数据限制在急诊科治疗，教育导致的成本低于对照组。
本综述发现，在急诊科实施的教育干预可降低随后哮喘患者的住院率。这些干预措施并未显著降低再次到急诊科就诊的情况；虽然效果趋势有利于教育干预，但汇总结果无统计学显著性。在此背景下，教育干预对哮喘发病率相关长期结局的影响尚不清楚。该领域进一步研究的重点包括评估与健康相关的生活质量、肺功能评估、探索社会经济地位与哮喘发病率之间的关系，以及对所评估干预措施进行更好的描述。
