Chronic disease management programmes for adults with asthma

Background The burden of asthma on patients and healthcare systems is substantial. Interventions have been developed to overcome difficulties in asthma management. These include chronic disease management programmes, which are more than simple patient education, encompassing a set of coherent interventions that centre on the patients' needs, encouraging the co‐ordination and integration of health services provided by a variety of healthcare professionals, and emphasising patient self‐management as well as patient education. Objectives To evaluate the effectiveness of chronic disease management programmes for adults with asthma. Search methods Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register, MEDLINE (MEDLINE In‐Process and Other Non‐Indexed Citations), EMBASE, CINAHL, and PsycINFO were searched up to June 2014. We also handsearched selected journals from 2000 to 2012 and scanned reference lists of relevant reviews. Selection criteria We included individual or cluster‐randomised controlled trials, non‐randomised controlled trials, and controlled before‐after studies comparing chronic disease management programmes with usual care in adults over 16 years of age with a diagnosis of asthma. The chronic disease management programmes had to satisfy at least the following five criteria: an organisational component targeting patients; an organisational component targeting healthcare professionals or the healthcare system, or both; patient education or self‐management support, or both; active involvement of two or more healthcare professionals in patient care; a minimum duration of three months. Data collection and analysis After an initial screen of the titles, two review authors working independently assessed the studies for eligibility and study quality; they also extracted the data. We contacted authors to obtain missing information and additional data, where necessary. We pooled results using the random‐effects model and reported the pooled mean or standardised mean differences (SMDs). Main results A total of 20 studies including 81,746 patients (median 129.5) were included in this review, with a follow‐up ranging from 3 to more than 12 months. Patients' mean age was 42.5 years, 60% were female, and their asthma was mostly rated as moderate to severe. Overall the studies were of moderate to low methodological quality, because of limitations in their design and the wi