Document Type

Article

Publication Date

4-2012

Abstract

Context: Asthma is a chronic respiratory disease increasingly prevalent in the U.S., particularly among children and certain minority groups. This umbrella review sought to assess and summarize existing systematic reviews of asthma-related interventions that might be carried out or supported by state or community asthma control programs, and to identify gaps in knowledge.

Evidence acquisition: Eleven databases were searched through September 2010, using terms related to four concepts: “asthma,” “review,” “intervention,” and “NOT medication.” Reviews of the effectiveness of medications, medical procedures, complementary and alternative medicine, psychological interventions, family therapy, and of nutrients or nutritional supplements were excluded. Two coders screened each record and extracted data from the included reviews.

Evidence synthesis: Of 42 included reviews, 19 assessed the effectiveness of education and/or self-management, 9 the reduction of indoor triggers, 9 interventions to improve the provision of health care, and 5 examined other interventions. Several reviews found consistent evidence of effectiveness for self-management education, and one review determined that comprehensive home-based interventions including the reduction of multiple indoor asthma triggers are effective for children. Other reviews found limited or insufficient evidence due to study limitations.

Conclusions: State or community asthma control programs should prioritize: 1) implementing interventions for which this review found evidence of effectiveness; and 2) evaluating promising interventions that have not yet been adequately assessed. Future research would be improved by standardizing definitions and measures across studies and adhering to quality guidelines when conducting systematic reviews. Well-designed research on health care system and policy interventions related to asthma is needed.

This is an Author's Accepted Manuscript of an article published in the April 2012 issue (volume 42, issue 4) of American Journal of Preventive Medicine, available online at: http://www.ajpmonline.org/article/S0749-3797%2812%2900023-2/ at the article DOI http://dx.doi.org/10.1016/j.amepre.2011.11.016.

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