Effect of Community-Based Interventions for Childhood Asthma: A Meta-Analysis
-
Yanyan Li
,
Ming Ren
,
Yajuan Wang
,
Xiaomi Qi
,
Hui Wang
,
Na Liang
,
Tianyang Ren
,
Lihong Zhang
Abstract
Background: This study aimed to appraise and compare the influence of community‑based interventions (C-BIs) on childhood asthma.
Methods: We reviewed meta-analysis data and used a dichotomous or continuous model with random or fixed effects to get odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CIs). This review included 13 papers and 8824 children with asthma. The range of studies years were between 2006 and 2024 from Google Scholar, Embase, Cochrane library, Pubmed, and OVID databases.
Results: Children with C-BI had significantly lower asthma-connected emergency department visits (OR, 0.29; 95% CI, 0.22-0.39, P<0.001), hospitalizations (OR, 0.24; 95% CI, 0.15-0.40, P<0.001), asthma symptoms days (MD, -2.56; 95% CI, -2.84- -2.28, P<0.001), nighttime asthma symptoms (MD, -2.14; 95% CI, -2.94- -1.34, P<0.001), and bronchodilator uses (OR, 0.28; 95% CI, 0.16-0.51, P<0.001), and higher asthma action plan use (OR, 8.87; 95% CI, 3.85-20.45, P<0.001) compared to children without C-BI in asthma.
Conclusion: Children with C-BI had significantly lower asthma-connected emergency department visits, hospitalizations, asthma symptoms days, nighttime asthma symptoms, bronchodilator use, and higher asthma action plan use compared to children without C-BI in asthma. Nevertheless, due to the limited number of research studies involved in the comparisons, their values warrant careful consideration.
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25. Lara M, Ramos-Valencia G, González-Gavillán JA, et al (2013). Reducing quality-of-care disparities in childhood asthma: La Red de Asma Infantil intervention in San Juan, Puerto Rico. Pediatrics, 131 Suppl 1:S26-S37.
26. Turyk M, Banda E, Chisum G, et al (2013). A multifaceted community-based asthma intervention in Chicago: effects of trigger reduction and self-management education on asthma morbidity. J Asthma, 50 (7):729-736.
27. Janevic MR, Stoll S, Wilkin M, et al (2016). Pediatric asthma care coordination in underserved communities: a quasiexperimental study. Am J Public Health, 106 (11):2012-2018.
28. Rapp KI, Jack Jr L, Wilson C, et al (2018). Improving asthma-related outcomes among children participating in the Head-off Environmental Asthma in Louisiana (HEAL), phase II study. Health Promot Pract, 19 (2):233-239.
29. Elliott JP, Morphew T, Gentile D, et al (2022). Improved asthma outcomes among at-risk children in a pharmacist-led, interdisciplinary school-based health clinic: A pilot study of the CAReS program. J Am Pharm Assoc (2003), 62 (2):519-525. e1.
30. Basnet S, Wroblewski K, Hansen E, et al (2024). Collaborative Integration of Community Health Workers in Hospitals and Health Centers to Reduce Pediatric Asthma Disparities: A Quality Improvement Program Evaluation. J Community Health, 49(4):682-692.
31. Bodenheimer T, Wagner EH, Grumbach K (2002). Improving primary care for patients with chronic illness. JAMA, 288 (14):1775-1779.
32. Wagner EH (1998). Chronic disease management: what will it take to improve care for chronic illness? Eff Clin Pract, 1(1):2-4.
33. Valery PC, Masters IB, Taylor B, et al (2010). An education intervention for childhood asthma by Aboriginal and Torres Strait Islander health workers: a randomised controlled trial. Med J Aust, 192 (10):574-579.
34. Wu F, Takaro TK (2007). Childhood asthma and environmental interventions. Environ Health Perspect, 115 (6):971-975.
35. Bernard-Bonnin A-C, Stachenko S, Bonin D, et al (1995). Self-management teaching programs and morbidity of pediatric asthma: a meta-analysis. J Allergy Clin Immunol, 95 (1 Pt 1):34-41.
36. Kanchongkittiphon W, Mendell MJ, Gaffin JM, et al (2015). Indoor environmental exposures and exacerbation of asthma: an update to the 2000 review by the Institute of Medicine. Environ Health Perspect, 123 (1):6-20.
37. Campbell JD, Brooks M, Hosokawa P, et al (2015). Community health worker home visits for Medicaid-enrolled children with asthma: effects on asthma outcomes and costs. Am J Public Health, 105 (11):2366-2372.
38. Bryant-Stephens T, Li Y (2008). Outcomes of a home-based environmental remediation for urban children with asthma. J Natl Med Assoc, 100 (3):306-316.
39. Dixon P, Hollinghurst S, Edwards L, et al (2016). Cost-effectiveness of telehealth for patients with raised cardiovascular disease risk: evidence from the Healthlines randomised controlled trial. BMJ Open, 6 (8):e012352.
40. Abdelrahim, M., P. Plant, and H. Chrystyn (2011). The relative lung and systemic bioavailability of terbutaline following nebulisation in non-invasively ventilated patients. Int J Pharm, 420 (2):313-318.
41. McLean S, Chandler D, Nurmatov U, et al (2011). Telehealthcare for asthma: a Cochrane review. CMAJ, 183 (11):E733-42.
2. Deloitte Access Economics. The hidden cost of asthma. Australia: Asthma Australia and National Asthma Council Australia; 2015.
3. Clark NM (2012). Community-based approaches to controlling childhood asthma. Annu Rev Public Health, 33:193-208.
4. Coffman JM, Cabana MD, Halpin HA, et al (2008). Effects of asthma education on children's use of acute care services: a meta-analysis. Pediatrics, 121 (3):575-586.
5. Elgendy, M.O., M.E. Abdelrahim, and R.S. Eldin (2015). Potential benefit of repeated dry powder inhaler’s inhalation technique counseling on asthmatic patients. Pulm Ther, 1 (1):91-101.
6. Liberati A, Altman DG, Tetzlaff J, et al (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol, 62 (10):e1-34.
7. Wong Z (2024). A meta-analysis examining the impact of antibiotic prophylaxis on surgical site wound infection during third molar surgery. Int J Clin Med Res, 2 (4):127-134.
8. Elshazly H (2024). Effectiveness of Postoperative Systemic Antibiotic Prophylaxis Following Cardiovascular Implantable Electronic Device Implantation: A Systematic Review and Meta-Analysis. Int J Clin Med Res, 2 (5):144-154.
9. Higgins JP, Thompson SG, Deeks JJ, et al (2003). Measuring inconsistency in meta-analyses. BMJ, 327 (7414):557-560.
10. Stroup DF, Berlin JA, Morton SC, et al (2000). Meta-analysis of observational studies in epidemiology: a proposal for reporting. JAMA, 283 (15):2008-2012.
11. Shafiey AS, Ahmed H (2025). Effect of Budesonide and Systemic Corticosteroids on Hospital Admissions and Length of Stay: A Meta-analysis. Int J Clin Med Res, 3 (2):24-29.
12. Gupta A, Das A, Majumder K, et al (2018). Obesity is Independently Associated With Increased Risk of Hepatocellular Cancer–related Mortality. Am J Clin Oncol, 41 (9):874-881.
13. Collaboration C (2020). RoB 2: A revised Cochrane risk-of-bias tool for randomized trials. Available at (Accessed December 6, 2019): bias/resources/rob-2-revised-cochrane-risk-bias-tool-randomized-trials
14. Sheikhbahaei S, Trahan TJ, Xiao J, et al (2016). FDG-PET/CT and MRI for evaluation of pathologic response to neoadjuvant chemotherapy in patients with breast cancer: a meta-analysis of diagnostic accuracy studies. Oncologist, 21 (8):931-939.
15. Larsen RA, Evans RS, Burke JP, et al (1989). Improved perioperative antibiotic use and reduced surgical wound infections through use of computer decision analysis. Infect Control Hosp Epidemiol, 10 (7):316-320.
16. Maki D, Schuna A (1978). A study of antimicrobial misuse in a university hospital. Am J Med Sci, 275 (3):271-282.
17. Singh RK (2023). A meta-analysis of the impact on gastrectomy versus endoscopic submucosal dissection for early stomach cancer. Int J Clin Med Res, 1 (3):88-99.
18. Portnoy JM, Jennings D (2006). Utilization patterns in an asthma intervention. Ann Allergy Asthma Immunol, 97(1 Suppl 1):S25-30.
19. Thyne SM, Rising JP, Legion V, et al (2006). The Yes, We Can Urban Asthma Partnership: a medical/social model for childhood asthma management. J Asthma, 43 (9):667-673.
20. Fox P, Porter PG, Lob SH, et al (2007). Improving asthma-related health outcomes among low-income, multiethnic, school-aged children: results of a demonstration project that combined continuous quality improvement and community health worker strategies. Pediatrics, 120 (4):e902-e911.
21. Lob SH, Boer JH, Porter PG, et al (2011). Promoting best-care practices in childhood asthma: quality improvement in community health centers. Pediatrics, 128 (1):20-28.
22. Mansfield C, Viswanathan M, Woodell C, et al (2011). Outcomes from a cross-site evaluation of a comprehensive pediatric asthma initiative incorporating translation of evidence-based interventions. Health Promot Pract, 12 (6 Suppl 1):34S-51S.
23. Findley S, Rosenthal M, Bryant-Stephens T, et al (2011). Community-based care coordination: practical applications for childhood asthma. Health Promot Pract, 12 (6 Suppl 1):52S-62S.
24. Woods ER, Bhaumik U, Sommer SJ, et al (2012). Community asthma initiative: evaluation of a quality improvement program for comprehensive asthma care. Pediatrics, 129 (3):465-472.
25. Lara M, Ramos-Valencia G, González-Gavillán JA, et al (2013). Reducing quality-of-care disparities in childhood asthma: La Red de Asma Infantil intervention in San Juan, Puerto Rico. Pediatrics, 131 Suppl 1:S26-S37.
26. Turyk M, Banda E, Chisum G, et al (2013). A multifaceted community-based asthma intervention in Chicago: effects of trigger reduction and self-management education on asthma morbidity. J Asthma, 50 (7):729-736.
27. Janevic MR, Stoll S, Wilkin M, et al (2016). Pediatric asthma care coordination in underserved communities: a quasiexperimental study. Am J Public Health, 106 (11):2012-2018.
28. Rapp KI, Jack Jr L, Wilson C, et al (2018). Improving asthma-related outcomes among children participating in the Head-off Environmental Asthma in Louisiana (HEAL), phase II study. Health Promot Pract, 19 (2):233-239.
29. Elliott JP, Morphew T, Gentile D, et al (2022). Improved asthma outcomes among at-risk children in a pharmacist-led, interdisciplinary school-based health clinic: A pilot study of the CAReS program. J Am Pharm Assoc (2003), 62 (2):519-525. e1.
30. Basnet S, Wroblewski K, Hansen E, et al (2024). Collaborative Integration of Community Health Workers in Hospitals and Health Centers to Reduce Pediatric Asthma Disparities: A Quality Improvement Program Evaluation. J Community Health, 49(4):682-692.
31. Bodenheimer T, Wagner EH, Grumbach K (2002). Improving primary care for patients with chronic illness. JAMA, 288 (14):1775-1779.
32. Wagner EH (1998). Chronic disease management: what will it take to improve care for chronic illness? Eff Clin Pract, 1(1):2-4.
33. Valery PC, Masters IB, Taylor B, et al (2010). An education intervention for childhood asthma by Aboriginal and Torres Strait Islander health workers: a randomised controlled trial. Med J Aust, 192 (10):574-579.
34. Wu F, Takaro TK (2007). Childhood asthma and environmental interventions. Environ Health Perspect, 115 (6):971-975.
35. Bernard-Bonnin A-C, Stachenko S, Bonin D, et al (1995). Self-management teaching programs and morbidity of pediatric asthma: a meta-analysis. J Allergy Clin Immunol, 95 (1 Pt 1):34-41.
36. Kanchongkittiphon W, Mendell MJ, Gaffin JM, et al (2015). Indoor environmental exposures and exacerbation of asthma: an update to the 2000 review by the Institute of Medicine. Environ Health Perspect, 123 (1):6-20.
37. Campbell JD, Brooks M, Hosokawa P, et al (2015). Community health worker home visits for Medicaid-enrolled children with asthma: effects on asthma outcomes and costs. Am J Public Health, 105 (11):2366-2372.
38. Bryant-Stephens T, Li Y (2008). Outcomes of a home-based environmental remediation for urban children with asthma. J Natl Med Assoc, 100 (3):306-316.
39. Dixon P, Hollinghurst S, Edwards L, et al (2016). Cost-effectiveness of telehealth for patients with raised cardiovascular disease risk: evidence from the Healthlines randomised controlled trial. BMJ Open, 6 (8):e012352.
40. Abdelrahim, M., P. Plant, and H. Chrystyn (2011). The relative lung and systemic bioavailability of terbutaline following nebulisation in non-invasively ventilated patients. Int J Pharm, 420 (2):313-318.
41. McLean S, Chandler D, Nurmatov U, et al (2011). Telehealthcare for asthma: a Cochrane review. CMAJ, 183 (11):E733-42.
| Files | ||
| Issue | Vol 55 No 1 (2026) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v55i1.20977 | |
| Keywords | ||
| Asthma Asthma-connected emergency Hospitalizations | ||
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How to Cite
1.
Li Y, Ren M, Wang Y, Qi X, Wang H, Liang N, Ren T, Zhang L. Effect of Community-Based Interventions for Childhood Asthma: A Meta-Analysis. Iran J Public Health. 2026;55(1):112-122.
