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Effectiveness of school-based self-management interventions for asthma among children and adolescents: findings from a Cochrane systematic review and meta-analysis
  1. Dylan Kneale1,
  2. Katherine Harris2,
  3. Vanessa M McDonald3,
  4. James Thomas1,
  5. Jonathan Grigg2
  1. 1Evidence for Policy and Practice Information and Coordinating Centre (EPPI-Centre), Social Science Research Unit, UCL Institute of Education, University College London, London, UK
  2. 2Centre for Child Health, The Blizard Institute, Queen Mary University London, London, UK
  3. 3Centre of Excellence in Severe Asthma, Priority Research Centre for Asthma and Respiratory Disease, School of Nursing and Midwifery, The University of Newcastle, Callaghan, New South Wales, Australia
  1. Correspondence to Dr Dylan Kneale, Evidence for Policy and Practice Information and Coordinating Centre (EPPI-Centre), Social Science Research Unit, UCL Institute of Education, London WC1H 0AL, UK; d.kneale{at}


Introduction The evidence that teaching self-management techniques to children and young people with asthma in schools is effective has not, to date, been the subject of systematic review.

Methods We conducted a systematic review of intervention studies. Studies were eligible if they employed a randomised parallel-group design and were published in English from 1995 onwards. Participants included children with asthma aged 5–18 years who participated within their own school environment. Searches were conducted on the Cochrane Airways Group Specialised Register. Quantitative data were combined using random-effects meta-analyses.

Results Thirty-three outcome evaluation studies were included. School-based interventions were effective in reducing the frequency of emergency department visits (OR 0.70, 95% CI 0.53 to 0.92; studies=13), and moderately effective in reducing levels of hospitalisations (standardised mean differences [SMD] −0.19, 95% CI −0.35 to −0.04; studies=6). A meta-analysis of three studies suggest that the intervention approach could reduce the number of days of restricted activity (SMD −0.30, 95% CI −0.41 to −0.18; studies=3). However, there was uncertainty as to whether school-based self-management interventions impacted on reducing absences from school.

Conclusions Self-management interventions for children with asthma delivered in schools reduce the number of acute episodes of healthcare usage. We conclude that the school environment is an important space for delivering interventions to improve children’s health.

  • paediatric asthma
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  • Contributors All authors contributed to study conception and protocol of the review. DK and KH performed the systematic review. DK and KH performed the statistical analysis. All authors contributed to the interpretation of data. DK and KH drafted the paper and all authors provided critical revisions and contributed to the editing of the paper. DK and KH are equal contributors to this manuscript.

  • Funding This research was funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care North Thames at Bart’s Health NHS Trust (NIHR CLAHRC North Thames).

  • Disclaimer The views expressed in this article are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.

  • Competing interests DK reports grants from NIHR CLAHRC North Thames during the conduct of the study; KH has nothing to disclose; VMM has nothing to disclose; JT reports grants from NIHR, during the conduct of the study; JG reports personal fees from GSK, personal fees from Vifor Pharmaceuticals, outside the submitted work.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data in this manuscript are available in a copublished review available from the Cochrane Library (

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