Weekly self-monitoring and treatment adjustment benefit patients with partly controlled and uncontrolled asthma: an analysis of the SMASHING study

Abstract

BackgroundInternet-based self-management has shown to improve asthma control and asthma related quality of life, but the improvements were only marginally clinically relevant for the group as a whole. We hypothesized that self-management guided by weekly monitoring of asthma control tailors pharmacological therapy to individual needs and improves asthma control for patients with partly controlled or uncontrolled asthma.MethodsIn a 1-year randomised controlled trial involving 200 adults (18-50 years) with mild to moderate persistent asthma we evaluated the adherence with weekly monitoring and effect on asthma control and pharmacological treatment of a self-management algorithm based on the Asthma Control Questionnaire (ACQ). Participants were assigned either to the Internet group (n = 101) that monitored asthma control weekly with the ACQ on the Internet and adjusted treatment using a self-management algorithm supervised by an asthma nurse specialist or to the usual care group (UC) (n = 99). We analysed 3 subgroups: patients with well controlled (ACQ ≤ 0.75), partly controlled (0.75>ACQ ≤ 1.5) or uncontrolled (ACQ>1.5) asthma at baseline.ResultsOverall monitoring adherence was 67% (95% CI, 60% to 74%). Improvements in ACQ score after 12 months were -0.14 (p = 0.23), -0.52 (p < 0.001) and -0.82 (p < 0.001) in the Internet group compared to usual care for patients with well, partly and uncontrolled asthma at baseline, respectively. Daily inhaled corticosteroid dose significantly increased in the Internet group compared to usual care in the first 3 months in patients with uncontrolled asthma (+278 μg, p = 0.001), but not in patients with well or partly controlled asthma. After one year there were no differences in daily inhaled corticosteroid use or long-acting β2-agonists between the Internet group and usual care.ConclusionsWeekly self-monitoring and subsequent treatment adjustment leads to improved asthma control in patients with partly and uncontrolled asthma at baseline and tailors asthma medication to individual patients' needs.Trial registrationCurrent Controlled Trials ISRCTN79864465

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.…”

“…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 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.…”

AsthmaWise – a field of dreams? The results of an online education program targeting older adults with asthma

“…Some of these interventions have shown improvements in asthma control (13,14,20) and lung function (20), but little change in quality of life (20) or asthma exacerbations (20).…”

“…Asthma education has the potential to be delivered online; however, to date, most of these self-management tools have included the monitoring of symptoms and the involvement of healthcare professionals such as the patient's physician or an asthma nurse (12)(13)(14)(15)(16)(17)(18)(19)(20). Some of these interventions have shown improvements in asthma control (13,14,20) and lung function (20), but little change in quality of life (20) or asthma exacerbations (20).…”