Long-Term Outcomes of Internet-Based Self-Management Support in Adults With Asthma: Randomized Controlled Trial

Abstract

BackgroundLong-term asthma management falls short of the goals set by international guidelines. The Internet is proposed as an attractive medium to support guided self-management in asthma. Recently, in a multicenter, pragmatic randomized controlled parallel trial with a follow-up period of 1 year, patients were allocated Internet-based self-management (IBSM) support (Internet group [IG]) or usual care (UC) alone. IBSM support was automatically terminated after 12 months of follow-up. In this study, IBSM support has been demonstrated to improve asthma-related quality of life, asthma control, lung function, and the number of symptom-free days as compared to UC. IBSM support was based on known key components for effective self-management and included weekly asthma control monitoring and treatment advice, online and group education, and communication (both online and offline) with a respiratory nurse.ObjectiveThe objective of the study was to assess the long-term effects of providing patients 1 year of IBSM support as compared to UC alone.MethodsTwo hundred adults with physician-diagnosed asthma (3 or more months of inhaled corticosteroids prescribed in the past year) from 37 general practices and 1 academic outpatient department who previously participated were invited by letter for additional follow-up at 1.5 years after finishing the study. The Asthma Control Questionnaire (ACQ) and the Asthma Quality of Life Questionnaire (AQLQ) were completed by 107 participants (60 UC participants and 47 IG participants). A minimal clinical important difference in both questionnaires is 0.5 on a 7-point scale.ResultsAt 30 months after baseline, a sustained and significant difference in terms of asthma-related quality of life of 0.29 (95% CI 0.01-0.57) and asthma control of -0.33 (95% CI -0.61 to -0.05) was found in favor of the IBSM group. No such differences were found for inhaled corticosteroid dosage or for lung function, measured as forced expiratory volume in 1 second.ConclusionsImprovements in asthma-related quality of life and asthma control were sustained in patients who received IBSM support for 1 year, even up to 1.5 years after terminating support. Future research should be focused on implementation of IBSM on a wider scale within routine asthma care.Trial RegistrationInternational Standard Randomized Controlled Trial Number (ISRCTN): 79864465; http://www.controlled-trials.com/ISRCTN79864465 (Archived by WebCite at http://www.webcitation.org/6J4VHhPk4).

Perspectives of patients and healthcare professionals on mHealth for asthma self-management

“…Web-based systems offer less burdensome self-management support, which may improve asthma outcomes [13]. Nowadays, smartphones have become an integral part of life and mobile healthcare (mHealth) systems are promising tools that may revolutionise asthma selfmanagement.…”

Application of Telemedicine for the Optimal Control of Asthma Patients

“…We have no evidence of studies with difficult to control asthmatic patients as the next therapeutic step is to introduce monitoring through an e-health system [29][30][31][32][33]. Short term outcomes in our study show a decrease of patients attending emergency room for asthma exacerbations, as well as improved adherence and treatment compliance which is leading to favourable clinical consequences trough improving respiratory function.…”

“…In the study by Van der Meer et al [29] with patients with mild to moderate persistent asthma, it was demonstrated that an internet-based self-management (IBSM) support program during 1 year leads to improved asthma-related quality of life, asthma control, lung function, and the number of symptom-free days as compared to usual care (UC) alone. A post hoc analysis of this study [30] showed that patients with asthma that were not well controlled benefited the most from IBSM support. In addition, this study showed that at 12 months of follow-up, about 60% of the patients were still using the program of their own initiative.…”

“…Image acquisition, storage, display, processing, and transfer, form the basis of telemedicine. In the last few years tele health, a more inclusive term, has grown exponentially [27][28][29][30][31].…”

“…In addition, this study showed that at 12 months of follow-up, about 60% of the patients were still using the program of their own initiative. Van Gaalen et al [30] published a randomized controlled trial about Long-Term Outcomes of InternetBased Self-Management Support in Adults With asthma demonstrating that Improvements in asthma-related quality of life and asthma control were sustained in patients who received IBSM support for 1 year, even up to 1.5 years after terminating support although no differences for inhaled corticosteroid dosage or for lung function, measured as forced expiratory volume in 1 second [31,32].…”