Behavioral interventions for asthma self-management in South Asian populations: a systematic review

Abstract

Objective

Asthma outcomes are significantly worse for minority groups, including South Asians (SAs), in high-income settings. Despite this, comparatively few existing studies have focused on SAs when studying the effectiveness of behavioral interventions on asthma self-management, and no prior study has synthesized these findings. We review the effectiveness of behavioral interventions on asthma management in adults and children of SA origin across low- (LICs), middle- (MICs), and high-income countries (HICs).

Methods

Data sources included EMBASE, MEDLINE, Cochrane Library and Trial registries: WHO, ICTRP and ClinicalTrials.gov. Eligibility criteria: randomized controlled trials (RCTs), quasi-RCTs and non-RCTs (controlled before-after [CBA] studies), published in English, with no publication year or country restrictions in adults and children of South Asian origin. Exclusion criteria: those focusing solely on pharmacological interventions. Search terms were “asthma” and “South Asian”.

Results

We included 33 studies, 27 from MICs and 6 from HICs (education [n = 10], self-management plans [n = 6], yoga/breathing exercises [n = 10]) organizational interventions [n =1], diet therapy [n = 1] and combined interventions [n = 5]). Outcome measures included: blood biochemistry, lung function, healthcare utilization and quality of life. A meta-analysis was not performed due to significant study heterogeneity.

Conclusion

Behavioral interventions for asthma management in SAs are effective. Educational interventions that aim to optimize asthma knowledge, control, and inhaler technique, and yoga/breathing exercises are most effective for improved long-term outcomes in adults and children across LICs and MICs. Further research is needed to evaluate the effectiveness of all behavioral interventions for SAs in HICs to better inform current guidance by policy makers and health care providers.

Keywords:

• Asthma
• Asian
• South Asian
• behavioral
• effectiveness

Acknowledgements

The authors would like to thank Mr. Virad Kisan (Medical Student, University College London) for his assistance in the development of this systematic review.

Declarations

Ethics approval and consent to participate: not applicable.

Consent to publish

Not applicable.

Availability of data and materials

All data generated and/or analyzed during this study are included in this published article (and its supplementary information files).

Disclosure statement

The authors declare that they have no conflicts of interests.

Funding

This research received no specific grant from any funding agency, commercial or not-for-profit sectors. ML and CL were (in part) supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames at Bart’s Health National Health Service (NHS) Trust. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

Author contributions

LM and ML conceived and participated in the design of the study. LM coordinated and RL and NO undertook the review. CL and EA coordinated and performed updated searches. All authors performed the data interpretation. CL and EA wrote the final manuscript. All authors read and approved the final manuscript. LM and ML are the study guarantors.