Summary of findings 1. Enhanced education compared with control versus usual care for people with asthma.

Enhanced education compared with control/usual care for people with asthma
Patient or population: adults and children with asthma Setting: primary and secondary care Intervention: enhanced education Comparison: control/usual care
Outcomes	Anticipated absolute effects* (95% CI)			Relative effect (95% CI)	Number of participants (studies)	Quality of the evidence (GRADE)	Comments
	Risk with control/usual care		Risk with enhanced education
Correct inhaler technique Follow‐up: 2 to 26 weeks (adults) 12 to 26 weeks (children)	Adults	31 per 100	69 per 100 (45 to 86)	OR 5.00 (1.83 to 13.65)	258 (3 RCTs)	⊕⊕⊕⊝ MODERATEa	Additional results from technique rating scales could not be combined (Analysis 1.2)
	Children	49 per 100	55 per 1,00 (40 to 69)	OR 1.29 (0.70 to 2.36)	175 (2 RCTs)	⊕⊕⊝⊝ LOWa,b	One study measured PIF as a marker for inhaler technique and showed benefit (Analysis 2.2; Analysis 2.3)
Asthma control score 4 to 26 weeks	Adults	‐	Score in the intervention group was 0.48 SDs higher than in the control group (0.29 lower to 1.24 higher)	‐	247 (2 RCTs)	⊕⊝⊝⊝ VERY LOWa,b,c	We were not able to calculate a control risk, as the outcome was measured on different scales
Asthma control responders 8 to 12 weeks	Adults	42 per 100	70 per 100 (52 to 84)	OR 3.18 (1.47 to 6.88)	134 (2 RCTs)	⊕⊕⊝⊝ LOWd
Exacerbations requiring at least OCS 26 weeks	Adults	10 per 100	13 per 100 (5 to 28)	OR 1.32 (0.49 to 3.55)	158 (1 RCT)	⊕⊕⊝⊝ LOWa,b	The same study also reported exacerbations requiring ED/hospitalisation. Events were rare and results imprecise
Quality of life 26 weeks	Adults	‐	Score in the intervention group was 0.52 SDs higher than in the control group (0.04 lower to 1.09 higher)	‐	247 (2 RCTs)	⊕⊕⊝⊝ LOWa,c,e	We were not able to calculate a control risk as the outcome was measured on different scales
Other outcomes	No results could be analysed for adverse events, unscheduled visits to a healthcare provider or school/work absences
*The risk in the intervention group (and its 95% confidence interval) is based on assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI) CI: confidence interval; ED: emergency department; OCS: oral corticosteroids; OR: odds ratio; PIF: peak inspiratory flow; RCT: randomised controlled trial; RR: risk ratio; SDs: standard deviations
GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to the estimate of effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of effect but may be substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

^aStudies contributing to this outcome were at high risk of bias in several domains (including performance and detection bias). Downgraded once

^bWide confidence intervals including possible harm and benefit of intervention. Downgraded once

^cHigh level of statistical inconsistency detected. Downgraded once

^dThe two small studies contributing to this outcome were identified as abstracts only; it is therefore difficult to assess methodological quality. Studies were considered at high or unclear risk of bias in multiple domains (including selection, performance, detection and reporting biases). Downgraded twice

^eConfidence interval includes no difference with random‐effects model, driven by statistical heterogeneity. Fixed‐effect sensitivity analysis yields more precise result. Not downgraded