COVID-19 is a rapidly evolving situation. When working in different community settings, follow CDC guidance External Web Site Icon to help prevent the spread of COVID-19. Visit www.cdc.gov/coronavirus External Web Site Icon for the latest public health information.

Asthma: School-Based Self-Management Interventions for Children and Adolescents with Asthma

Tabs

What the CPSTF Found

About The Systematic Review

The CPSTF uses recently published systematic reviews to conduct accelerated assessments of interventions that could provide program planners and decision-makers with additional effective options. The following published review was selected and evaluated by a team of specialists in systematic review methods, and in research, practice, and policy related to asthma.

Harris KM, Kneale D, Lasserson TJ, McDonald VM, Grigg J, Thomas J. School-based self-management interventions for asthma in children and adolescents: a mixed methods systematic review. Cochrane Database of Systematic Reviews 2019, Issue 1. Art. No.: CD011651. DOI:10.1002/14651858.CD011651.pub2

The review included 33 studies (search period through August 28, 2017). The team examined each of the studies included in the systematic review and abstracted supplemental information about study, intervention, and population characteristics.

The CPSTF finding is based on results from the published review, additional information from the included studies, and expert input from team members and the CPSTF.

Context

Schools provide a unique opportunity for asthma control activities. They can educate students, parents, and staff about asthma prevention and control, take steps to remove or reduce asthma triggers, and offer students healthcare services. School-based interventions are an important component of a comprehensive community and health system approach to asthma control.

Summary of Results

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

The published systematic review included 33 randomized controlled trials. Three of these studies did not measure any of the review’s outcomes of interest and were not included in the CPSTF analysis.

  • A meta-analysis of 19 studies reported the following effects of school-based self-management interventions:
    • Reductions in asthma-related emergency department visits (13 studies)
    • Reductions in asthma-related hospitalizations (6 studies)
    • Reductions in unplanned visits to a medical provider (5 studies)
    • Increases in self-reported asthma-related quality of life (7 studies)
    • Mixed results for all causes of school absences (10 studies)
  • Studies also measured intervention effects on asthma control outcomes. Compared with controls, students in self-management intervention groups reported the following:
    • Less need for the use of asthma reliever medications (6 studies)
    • Fewer activity limitations (6 studies)
    • Little or no change in self-reported day-time or night-time symptoms (12 studies) or measures of lung function (6 studies)

Summary of Economic Evidence

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

There was not enough economic evidence to determine cost-effectiveness or cost-benefit for school-based asthma self-management interventions.

The economic review included 8 studies (search period 1995 through May 2020). Seven studies reported intervention cost, three included the averted cost of healthcare, and two reported return on investment or provided sufficient information for the economic review team to compute it. All monetary values are reported in 2019 U.S. dollars.

Intervention Cost

  • The median cost per person was $44 (IQI: $40 to $131), based on eight estimates from seven studies.
  • The variation in intervention cost is partly explained by differences in the size of intervention groups, with smaller intervention costs associated with larger groups.

Economic Benefit

  • The changes in healthcare cost per person were -$208, $0, and $62, based on estimates from three studies.

Return on Investment

  • The return on investment was -1 and -2.5, based on two studies that reported both intervention cost and change in healthcare cost. The negative values indicate intervention cost exceeded the healthcare cost averted.

Applicability

Based on results from the review, the finding should be applicable to U.S. school children and adolescents with asthma.

Evidence Gaps

The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

  • How effective are these interventions with high school students who have asthma?
  • How does effectiveness vary between programs set in urban and rural schools? Future studies could inform and provide additional evidence on programs and program components in rural settings.
  • Does teaching students how to use inhalers and following up with them to ensure proper use have an effect on asthma-related outcomes?
  • Do additional school policies (e.g. child inhaler possession and use policies, requirements for asthma action plans) improve student self-management practices and overall asthma control?
  • How does effectiveness vary by asthma severity?

Study Characteristics

  • Included studies were conducted in the United States (19 studies), Canada (4 studies), Australia (2 studies), the United Kingdom (2 studies), China (1 study), Jordan (1 study), and Spain (1 study).
  • The published systematic review included 33 randomized controlled trials that assigned groups by student (6 studies) or school (26 studies); one study did not report this information.
  • Studies included students aged 5 to 10 years (20 studies), 11 to 15 years (14 studies), and 16 years and older (1 study). Most studies were conducted in elementary schools and/or middle schools (21 studies).
  • Studies most often recruited students by using surveys or announcements (50%), or health records (27%).