Childhood Asthma is Better Controlled with Education

A meta-analysis finds that providing both parents and children with asthma with information about managing their disease can reduce emergency room visits and hospitalizations.

Health education that included both parents and children with asthma has a positive impact on outcomes and was associated with a 54% lower hospitalization risk and a 31% lower emergency department visit risk, according to a review of studies that was published in February 2022 in the journal Archives of Disease in Childhood.

Asthma is a disease that affects the lungs; it is caused by inflammation in inner lining of the lungs, causing the airways to swell and produce mucus. Asthma results episodes of wheezing, breathlessness, chest tightness, and coughing.

About half of those with asthma have what is called type 2 inflammation. Researchers have discovered that asthma is characterized by the release of cytokines IL-4, IL-5, and IL-13 from cells of both the innate and the adaptive immune systems. Previously, researchers believed that only the adaptive immune response was involved. These cytokines play a role in the symptoms experienced by those with asthma.

Biomarkers of this type of asthma include elevated serum immunoglobulin E (IgE), eosinophils, and fractional exhaled nitric oxide (FeNO). Investigators say these biomarkers could be used for improved diagnosis and treatment.

About 25 million Americans have asthma. This equals to about 1 in 13 Americans, including 8% of adults and 7% of children, according to the CDC. It is the leading chronic disease in children. Currently, there are about 5.1 million children under the age of 18 with asthma, and it is more common in boys than girls.

To conduct the meta-analysis of asthma education outcomes, Wen-Yi Liu of the Department of Health Policy Management at the Johns Hopkins Bloomberg School of Public Health, and colleagues searched the Cochrane Library, PubMed and EMBASE for studies that reported hospitalization or emergency department or clinic visits as outcomes in children with asthma. They found 15 studies published between 1991 and 2020 that met their criteria and included these in their meta-analysis.

The outcomes of 12 papers included hospitalizations. The outcomes of 13 others were emergency visits. In the early studies, the most common teaching tools were face-to-face sessions and handouts. Later, information on Internet and videos were used.

Investigators in this analysis found that asthma education targeted at both children and parents could significantly reduce hospitalization and emergency department visits. And while asthma education targeted at only children or parents impacted emergency department visits, it did not result in reduced hospitalizations.

“Clinically, understanding the effect of education on asthma is critical for applying adequate preventive measures to control the prevalence of asthma in children. Furthermore, the subgroup analysis of the participants and the context of education is also useful in understanding the overall impact of education on asthma,” investigators wrote.