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Efficacy: Following a meta-analysis of 11 randomized clinical trials of self-management teaching programs, Bernard-Bonnin et al concluded that educational programs improve knowledge but do not reduce morbidity, consistent with the results of the randomized studies conducted by Garrett et al and Cote et al . These data, as well as those showing the discrepancy between knowledge and behaviour , indicate that relying on an assessment of knowledge as the sole outcome measure may grossly overestimate the effectiveness of an educational strategy. Assessment of trials of asthma educational interventions are complicated by a variety of factors: the use of selected study populations (so that results are not necessarily gener-alizable); different baseline levels of self-management knowledge and skills; different types of intervention; presence of confounding factors and different primary outcomes; and variable responses due to psychological, social and economic factors. Other issues are contamination of the control group and what constitutes the control intervention; often a substantial improvement in both the control and intervention groups occurs without a significant intergroup difference . Given that the majority of patients with asthma have mild symptoms, traditional indexes of morbidity may not be the most appropriate outcome to monitor. Asthma educational programs have been shown to improve asthma-specific quality of life , and perhaps this should be a primary outcome variable in intervention studies.