Education interventions for adults who attend the emergency room for acute asthma

A new review of studies suggests that people with asthma who receive disease education during, or soon after, a serious emergency-room visit are less likely to be re-admitted to the hospital than patients who receive no instruction.

“We've known for a long time that education works in chronic diseases and education in the emergency department makes good sense," said review co-author Brian Rowe, an emergency physician at the University of Alberta Hospital in Edmonton, AB.

The reviewers analyzed 12 randomized controlled studies involving 1,954 patients. All study participants visited the emergency department for a severe asthma attack. Some patient groups received usual care plus asthma education; others received usual care only.

Doctors say education and self-management training are mainstays of most chronic diseases, such as asthma, diabetes and hypertension. The goal is to teach patients to maintain better control of their illness, which might improve health and require less interaction with the healthcare system.

Frequency of re-hospitalization was lower for patients who received asthma education, the review found. Education after an emergency room visit also appears to improve patient attendance at scheduled medical appointments.

However, there was little evidence to suggest that education improved other health indicators such as lung function, lost days at work, quality of life or the need to use rescue medications.

The review appears in the latest issue of The Cochrane Library , a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Asthma education varied greatly across the 12 analyzed studies. The programs included everything from counseling to information about monitoring symptoms and airway constriction to information about what actions to take if asthma worsens.

“We still aren't sure which components of education are essential and which can be eliminated without a loss of effectiveness,” Rowe said.

Different healthcare professionals (nurses, doctors, educators) delivered the instruction in different settings (clinics, emergency rooms, home).

The review did not determine which professionals provided the best asthma instruction. Nevertheless, Rowe said, "Physicians generally don't have time to provide education in the chaotic environment of the ED and they, perhaps, are not very effective at providing the type of education needed for this and other chronic diseases in this setting."

"Certified asthma educators, pharmacists and other healthcare providers may be more effective and efficient at providing this education,” he said.

The reviewed studies measured considerably different health outcomes – sometimes simply a return visit to the emergency room, sometimes admissions to the hospital. Six studies, involving 665 participants, found that education resulted in a significant reduction of repeat hospital stays after the emergency department visit. Seven studies involving 690 participants found no significant differences in subsequent visits to the emergency department between patients who received education and those who did not.

The differing educational programs and varying health measures made it difficult to draw conclusions from the studies.

"It tells us that we need to be very specific in outcome measurements and to specify at the beginning what intervention we are going to make,” said William Calhoun, director of Allergy, Pulmonary, Immunology, Critical Care and Sleep at the University of Texas Medical Branch in Galveston, Texas.

"We need very clear, well-designed studies on asthma education and its effects,” Calhoun said. He did not participate in the Cochrane review.

The review authors said the limitations of the current analysis reveal a strong need for further study into asthma education interventions. In the future, they would like to see better health outcome reporting and a review of socioeconomic and cultural factors that could effect asthma management and health.

Tapp S, et al. Education interventions for adults who attend the emergency room for acute asthma (Review). Cochrane Database of Systematic Reviews 2007, Issue 3.

The Cochrane Collaboration is an international non-profit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit http://www.cochrane.org for more information.