Health Evidence Bulletins - Wales
Team Leader: Dr Michael Burr Date of completion: 5/3/98

The contents of this bulletin are likely to be valid for approximately one year, by which time significantly new research evidence may become available

5. Asthma - Non-drug management

(Users are advised to consult the supporting evidence for a consideration of all the implications of a recommendation)

The Statements The Evidence
5a. Methods currently available for reducing exposure to the house-dust mite tend to be ineffective, at least in the way that they are usually employedi.

(Health gain notation - 5 "unlikely to be beneficial")
There is a need for trials of more rigorous methods of mite-eradication in mite-sensitive asthmatics.

i. Hammarquist C, Burr ML, Gotzsche PC. House dust mite control measures in the management of asthma: a systematic review. Cochrane Library in preparation
5b. Self-management teaching programmes in children have mostly been disappointingi although, when administered during an acute hospital admission, they can be effective (subsequent readmissions were significantly reduced from 25% to 8% in individual follow-up periods which ranged from 1-14 months)ii. Among adults they seem to confer benefitiii.
(Health gain notation - 2 "likely to be beneficial").
Outcomes measured were absence from school or work, attacks, need for treatment, emergency consultations and hospital admissions.It cannot be assumed that the programme for adults that worked well in Finland would necessarily work here. In view of the importance of current self-management in treating this disease, studies should be set up in the UK.
i. Bernard-Bonnin A-C, Stachenko S, Bonin D, Charette C, Rousseau E. Self-management teaching programs and morbidity of pediatric asthma: a meta-analysis. Journal of Allergy and Clinical Immunology 1995; 95: 34-41
(Type I evidence - meta-analysis);
ii. Madge P, McColl J, Paton J. Impact of a nurse-led home management training programme in children admitted to hospital with acute asthma: a randomised controlled study. Thorax 1997; 52: 223-228
(Type II evidence - randomised controlled trial);
iii. Lahdensuo A, Haahtela T, Herrala J et al. Randomised comparison of guided self management and traditional treatment of asthma over one year. British Medical Journal 1996; 312: 748-752

(Type II evidence - randomised controlled trial)
5c. Desensitization (immunotherapy) for mites, pollens and other allergens is effective for selected patients (with reductions in symptoms and the need for medication, and improved lung function) but the benefits must be balanced against risk of serious reactions including death from anaphylaxis i.
(Health gain notation -3 "trade-off between beneficial and adverse effects")
i. Abramson MJ, Puy RM, Weiner JM. Is allergen immunotherapy effective in asthma? A meta-analysis of randomized controlled trials. American Journal of Respiratory and Critical Care Medicine 1995; 151: 969-974
(Type I evidence - meta-analysis)

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Health Evidence Bulletins: Wales, Duthie Library, UWCM, Cardiff CF14 4XN. e-mail: