SELF-MANAGEMENT TEACHING PROGRAMS AND MORBIDITY OF PEDIATRIC ASTHMA - A METAANALYSIS

Background: Self-management teaching programs are becoming an important asset in the management of pediatric asthma. Objective: The study was designed to evaluate the impact of self-management teaching programs on the morbidity of pediatric asthma. Methods: The meta-analysis included randomized clinical trials, published between 1970 and 1991, addressing the outcome of morbidity. Studies were retrieved from searches of MEDLINE, American Journal of Nursing International Index, and Dissertation Abstracts Online Database. The quality of studies was assessed with the scale of Chalmers. The pooled effect size was calculated by the method of Hedges. Results: The literature search retrieved 23 randomized clinical trials, but 12 studies had to be excluded. Global score of quality of studies (Chalmers' scale) was fair, 51.6% +/- 9.9%. As indicated by the effect size (ES) of the pooled studies, self-management teaching did not reduce school absenteeism (ES: 0.04 +/- 0.08), asthma attacks (ES: 0.09 +/- 0.14), hospitalizations (ES: 0.06 +/- 0.08), hospital days (ES: -0.11 +/- 0.08), or emergency visits (0.14 +/- 0.09). Conclusion: Self-management teaching programs do not seem to reduce morbidity and future programs should focus more on intermediate outcomes such as behavior.