The Clinical Use of an Internet-based Asthma Teleconsultation System

Abstract

Background: Self-assessment and self-management are the goals of long-term bronchial asthma care. The adherence to asthma management guidelines is generally poor. An electronic computer system with automatic assessment may increase awareness of the control status and provide more comprehensive recommendations for asthma management. Objectives: To evaluate the clinical usefulness of an internet-based asthma teleconsultation system (TCS) for asthma patients' self assessment and management. Methods: The TCS was built on a free website with software to assess asthma severity, and to suggest possible precipitating factors by calculating the mean PEFR, PEFR variation, rescue medication use, and asthma symptoms. Assessment and management recommendations complying with GINA guidelines are automatically shown after the data entry. The consensus between the TCS and 4 senior asthma specialists was validated for asthma severity assessment and corresponding management recommendations. The rating of the asthma control test was obtained by phone 4 weeks thereafter. Results: One hundred thirty-four asthmatics with variability were recruited from clinical return visits. No difference in asthma severity assessment existed between the TCS and asthma specialists. The causes of asthma instability identified by the asthma specialists were consistent with the TCS, except for 1 case. The asthma specialists disagreed with the TCS management recommendations for 11 patients (8.2%). The agreement between the TCS and the asthma specialists in management was excellent, with a kappa statistic of 0.822. By following the TCS recommendation, 88% of asthmatic patients improved their asthma control, although 12% of patients were still rated not controlled by the Asthma Control Test (ACT). No emergency visits, hospitalizations or unscheduled clinic visits occurred during the 4 weeks of follow-up. Conclusion: The internet-based asthma TCS is accurate and reliable for both patients and physicians.