Internet-Based Self-Management Support After High-Altitude Climate Treatment for Severe Asthma: Randomized Controlled Trial

Abstract

Background In patients with severe asthma, high-altitude climate treatment has been shown to improve asthma control. However, asthma symptoms and limitations may increase after finishing inpatient rehabilitation programs and returning to sea level. Objective We assessed the effectiveness of a patient-tailored, internet-based, self-management strategy in addition to usual care after finishing high-altitude climate treatment. Methods We performed a randomized controlled trial with a 1-year follow-up in patients from a high-altitude asthma center in Davos, Switzerland. At the end of a 12-week multidisciplinary rehabilitation program, 62 adults with asthma were randomized to receive either internet-based self-management support in addition to usual care (n=33) or usual care only after discharge (n=29). The endpoints were changes in asthma-related quality of life according to the Asthma Quality of Life Questionnaire (AQLQ) (a higher score is better) and asthma control according to the Asthma Control Questionnaire (ACQ) (a lower score is better), with a minimally important difference of 0.5 points for both. Results Asthma-related quality of life and asthma control declined over time in the usual care strategy group, whereas there was a slower decline in the internet-based strategy group. For both endpoints, mixed-model analysis showed a significant positive effect in favor of internet-based self-management during follow-up (mean AQLQ score difference 0.39, 95% CI 0.092-0.69; P=.01 and ACQ score difference −0.50, 95% CI −0.86 to −0.15; P=.006), which was prominent among patients with uncontrolled asthma at discharge (AQLQ score difference 0.59, 95% CI 0.19-0.99; P=.003 and ACQ score difference −0.73, 95% CI −1.18 to −0.28; P=.002). Conclusions Internet-based self-management support was associated with a smaller decline in quality of life and asthma control as compared with usual care, especially in patients with lower asthma control, after completion of high-altitude climate treatment. Internet-based self-management support in adults with severe asthma seems feasible and effective to maintain quality of life and asthma control. Trial Registration The trial is registered in the Netherlands Trial Register (NTR1995).

Alpine altitude climate treatment for severe and uncontrolled asthma: An EAACI position paper

“…The use of Internet-based self-management applications in the home situation contributes toward sustaining improved asthma control after AACT. 137…”

“…They also guarantee continuity in asthma care when the patient returns to the referring physician. The use of Internet‐based self‐management applications in the home situation contributes toward sustaining improved asthma control after AACT 137 Most AACT programs contain an extensive patient assessment, psychological and behavioral interventions, personalized exercise programs, extensive patient education, and personalized action plans for use after the end of treatment. The specific effectiveness of AACT may lie in the observed rapid decrease in inflammation, either because of fewer environmental triggers in the alpine climate or the physical altitude climate factors and its immunomodulatory effects or other yet unknown mechanisms. …”

Detecting and Treating Psychosocial and Lifestyle-Related Difficulties in Chronic Disease: Development and Treatment Protocol of the E-GOAL eHealth Care Pathway

“…A potential strength of the eHealth care pathway is its flexibility for usage in patient populations with different lifestyle-related chronic diseases [ 19 ]. Trial results indicate the feasibility and effectiveness of other versions of the screening tool and the iCBT treatment among individuals with asthma, psoriasis, and rheumatoid arthritis [ 30 , 31 , 32 ]. Furthermore, the iCBT intervention is already being applied in clinical practice, as part of regular CBT for individuals with a broad range of chronic diseases in the Netherlands (reimbursed by insurance companies), which is also a promising sign for the generalizability of the E-GOAL eHealth care pathway.…”

“…The screening tool consists of (1) screening questionnaires to identify patients with an increased-risk profile—who experience psychosocial and lifestyle-related difficulties—as well as questionnaires to tailor the intervention, and (2) personal profile charts to visualize screening results. The screening tool was embedded in the online platform “PatientCoach”, an eHealth application to support patients with chronic somatic diseases, developed and hosted at Leiden University Medical Center (LUMC) [ 32 ].…”

“…This feedback was incorporated in the final eHealth care pathway. After developing the content of the screening tool (questionnaires with cut-off points for increased-risk profiles, as well as personal profile charts), it was built into the eHealth application PatientCoach [ 32 ], as introduced before. The tool was extensively tested before patients were invited for usage.…”