Using the same search strategies and approach as above, we identified 408 examples of asthma interventions trialled for, with or on children: four were targeted to South Asians, 22 were targeted to another ethnic minority group, 134 targeted to a specific group (but not an ethnic minority, e.g. inner-city children) and 252 were generic. In addition, we identified 15 systematic and non-systematic reviews of asthma interventions for children.
Of the four targeted to South Asians, three focused on education and clinical support. One included additional elements of raising awareness. All of the interventions targeted both adults and children; no studies with interventions specifically targeted at South Asian children alone were identified (see for details).
Four citations relevant to South Asian children
Moudgil et al.213 assessed the impact of a patient education and GP support programme for White and non-White groups in reducing asthma morbidity in 2000. This study included patients aged 11–60 years. Six hundred and ninety-eight patients were recruited, of whom 42% were of South Asian ethnicity; of those, 42% were born outside the UK (India, Pakistan, and East and Central Africa) and 34% spoke no or very little English. Patients received an individualised asthma education programme which was reinforced after 4 and 8 months, and GPs were given advice and equipment. The results showed that, overall, the active intervention group had reduced GP consultations, reduced accident and emergency attendance, reduced hospital admission, reduced prescriptions for rescue oral steroids and less antibiotics. However, when stratified by ethnicity, significant improvements were seen only in the White European group, not in the south Asian group. Asthma Quality of Life Questionnaire (AQLQ) scores demonstrated lower values associated with South Asian ethnicity, although there were small but significant changes in AQLQ scores recorded over the length of the study in both White European and South Asian groups, suggesting that both White and South Asian patients are responsive to the Hawthorne Effect, although the intervention itself was less effective in South Asians.
The ELECTRA study, Griffiths et al.,56 tested a liaison model of specialist nursing in 2004 with asthmatic patients aged 4–60 years old. This study combined the education of patients after discharge with educational outreach and clinical support for primary care clinicians in the Tower Hamlets region of London. The study aimed to identify whether or not specialist nurses could reduce health service use, and do so equally in different ethnic populations. The intervention delayed time to first attendance with acute asthma, reduced the percentage of participants attending with acute asthma, and increased the percentage of patients with reviews in primary care but showed no effect on self-management skills, quality of life or frequency of symptoms. When analysed by ethnic group, the results were consistent with (but non-significant for) a greater benefit for white patients than for South Asian patients or those from other ethnic groups.
The OEDIPUS study continued on the work started in ELECTRA but focused exclusively on South Asian patients. An established educational programme from the USA (PACE – physician asthma care education) was adapted for use in the UK with South Asian patients aged 4–60 years. Practice nurses and GPs were trained using PACE and patients received either PACE-style management or standard management. The study found that while attendance at asthma reviews improved, there was no change in acute exacerbations.
The final study reports on a community-based nurse-led clinic for the assessment, diagnosis, education and treatment of asthma. Although not exclusive to South Asian participants, the location was established in an area with a predominantly South Asian population. In addition to intervening in service provision, the study reports that workshops and talks were held to raise awareness and acceptability of asthma. However, while the study reports that standards of care were improved (assessed by agreement with the BTS guidelines on asthma management), no clinical or personal outcomes were measured.
