Impact of non-drug therapies on asthma control: A systematic review of the literature

Abstract

Background: Despite growing access to effective therapies, asthma control still needs improvement. Many non-drug factors, such as allergens, air pollutants and stress also affect asthma control and patient quality of life, but an overview of the effectiveness of non-drug interventions on asthma control was lacking. Objectives: To identify non-drug interventions likely to improve asthma control. Methods: A systematic review of the available literature in Medline and the Cochrane Library was conducted in March 2017, without any time limit. Initial searching identified 884 potentially relevant clinical trial reports, literature reviews and meta-analyses, which were screened for inclusion using criteria of quality, relevance, and reporting outcomes based on asthma control. Results: Eighty-two publications met the inclusion criteria. In general, the quality of the studies was low. Patient education programmes (22 studies) significantly improved asthma control. Multifaceted interventions (10 studies), which combined patient education programmes with decreasing exposure to indoor allergens and pollutants, significantly improved asthma control based on clinically relevant outcomes. Renovating homes to reduce exposure to allergens and indoor pollutants improved control (two studies). Air filtration systems (five studies) were effective, especially in children exposed to second-hand smoke. Most measures attempting to reduce exposure to dust mites were ineffective (five studies). Dietary interventions (eight studies) were ineffective. Promoting physical activity (five studies) tended to yield positive results, but the results did not attain significance. Conclusion: Twenty-six interventions were effective in asthma control. Simultaneously combining several action plans, each focusing on different aspects of asthma management, seems most likely to be effective.

Non-drug treatments and rehabilitation of patients with bronchial asthma

“…Our review confirms that therapeutic training programs for patients significantly improve asthma control [117,118]. But as most scientists point out, a program focused on various factors in the fight against asthma is needed, similar to the coordinated French program EPODE, aimed at reducing childhood obesity [125].…”

“…However, it does not seem possible to identify the most effective therapeutic training programs for patients among more than 20 programs. Telemedicine training, written diaries for asthma self-monitoring (WAP) also reduce the risk of hospitalization, especially for patients with severe asthma [121,122,123], the best effect is achieved with multifaceted (combined) educational methods in primary care [124,125].…”

Asthma and COVID-19: review of evidence on risks and management considerations

“…70 Self-care interventions which have shown promise for asthma control also include decreasing exposure to allergens and pollutants, though there are some issues with study quality in this area. 71 Systematic reviews differ regarding the effectiveness of air filtration systems. 71 72 Weight loss in PWA with overweight or obesity may also improve asthma control in adults 73 and children, 74 though issues with the evidence have been noted.…”

Management of paediatric asthma

“…Asthma control is significantly more likely in patients that are educated (know their disease), are regularly taught to use the inhaler device, have a written action plan and educational material (www.asthma.co.za) and are encouraged to use controller medication regularly. 8…”