Abstract
BackgroundInternet-based self-management programs improve asthma control and the asthma-related quality of life in adults and adolescents. The components of self-management programs include education and the web-based self-monitoring of symptoms; the latter requires adequate perception in order to timely adjust lifestyle or medication or to contact a care provider.ObjectiveWe aimed to test the hypothesis that adherence to education and web-based monitoring and adequate symptom perception are important determinants for the improvement of asthma control in self-management programs.MethodsWe conducted a subgroup analysis of the intervention group of a randomized controlled trial, which included adolescents who participated in the internet-based self-management arm. We assessed the impacts that attendance in education sessions, the frequency of web-based monitoring, and the level of perception had on changes in asthma control (Asthma Control Questionnaire [ACQ]) and asthma-related quality of life (Pediatric Asthma Quality of Life Questionnaire) from baseline to 12 months after intervention.ResultsAdolescents who attended education sessions had significant and clinically relevant improvements in asthma control (ACQ score difference: −0.6; P=.03) and exhibited a nonsignificant trend of improvement in asthma-related quality of life (Pediatric Asthma Quality of Life Questionnaire score difference: −0.45; P=.15) when compared to those who did not adhere to education. Frequent monitoring alone did not improve asthma control (P=.07) and quality of life (P=.44) significantly, but its combination with education did result in improved ACQ scores (difference: −0.88; P=.02). There were no significant differences in outcomes between normoperceivers and hypoperceivers.ConclusionsEducation, especially in combination with frequent web-based monitoring, is an important determinant for the 1-year outcomes of asthma control in internet-based self-management programs for adolescents with partly controlled and uncontrolled asthma; however, we could not establish the effect of symptom perception. This study provides important knowledge on the effects of asthma education and monitoring in daily life.
Highlights
Asthma control is the goal in long-term asthma management, but despite the availability of effective therapies, this goal is not reached in three-quarters of patients with persistent asthma [1,2,3]
Asthma control and asthma-related quality of life can be improved in adults and adolescents, and the number of outpatient visits can be reduced by participating in an internet-based self-management (IBSM) support program [7,8,9,10]
This study is a secondary analysis of the Self-Management in Asthma Supported by Hospitals, Internet, Nurses and General Practitioners (SMASHING) trial [11], which we conducted in order to assess whether (1) adherence to education, (2) the amount of symptom monitoring, and (3) the level of symptom perception are related to improvements in asthma control and asthma-related quality of life in adolescents with partly controlled and uncontrolled asthma
Summary
Asthma control is the goal in long-term asthma management, but despite the availability of effective therapies, this goal is not reached in three-quarters of patients with persistent asthma [1,2,3]. We did not assess which factors predicted favorable outcomes among the intervention group after the 12-month follow-up These adolescents had access to education and self-monitored their asthma control, which are important components of self-management [7,11,12]. We hypothesized that adherence to education sessions, frequent web-based monitoring, and an adequate perception of dyspnea are prerequisites to improving asthma control, asthma-related quality of life, and lung function after 12 months. Conclusions: Education, especially in combination with frequent web-based monitoring, is an important determinant for the 1-year outcomes of asthma control in internet-based self-management programs for adolescents with partly controlled and uncontrolled asthma; we could not establish the effect of symptom perception. This study provides important knowledge on the effects of asthma education and monitoring in daily life
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