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
Highlights
Internet-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
Lung function is only included in the Asthma Control Questionnaire (ACQ) [4]
In the present preplanned analysis we investigated whether a simple index of asthma control can be used to predict the outcomes of Internet-based self-management
Summary
Internet-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. Recent international guidelines define asthma control in terms of two domains: impairment and risk [1,2]. The distinction between these two domains for assessing asthma control emphasizes the need to consider sepa-. Well-validated self-assessment questionnaires are available to periodically monitor the van der Meer et al Respiratory Research 2010, 11:74 http://respiratory-research.com/content/11/1/74 level of asthma control [4,5,6]. Each of these instruments assesses the impairment domain by measuring asthma symptoms, limitation of activities and need for rescue medication. The periodic assessment of lung function is important, since it captures both asthma impairment at present and may detect future risk of progressive lung function and exacerbations [7,8]
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