Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2013 Sep 12;15(9):e188.
doi: 10.2196/jmir.2640.

Long-term outcomes of internet-based self-management support in adults with asthma: randomized controlled trial

Johanna L van Gaalen  1 , Thijs Beerthuizen, Victor van der Meer, Patricia van Reisen, Geertje W Redelijkheid, Jiska B Snoeck-Stroband, Jacob K Sont; SMASHING Study Group
Collaborators, Affiliations
Randomized Controlled Trial

Long-term outcomes of internet-based self-management support in adults with asthma: randomized controlled trial

Johanna L van Gaalen et al. J Med Internet Res. .

Abstract

Background: Long-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.

Objective: The objective of the study was to assess the long-term effects of providing patients 1 year of IBSM support as compared to UC alone.

Methods: Two 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.

Results: At 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.

Conclusions: 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. Future research should be focused on implementation of IBSM on a wider scale within routine asthma care.

Trial registration: International Standard Randomized Controlled Trial Number (ISRCTN): 79864465; http://www.controlled-trials.com/ISRCTN79864465 (Archived by WebCite at http://www.webcitation.org/6J4VHhPk4).

Keywords: Internet; asthma; eHealth; long-term; quality of life; self-management; telemedicine.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Treatment algorithm.
Figure 2
Figure 2
Traffic light display.
Figure 3
Figure 3
Flowchart of study participants.
Figure 4
Figure 4
Mean Asthma Quality of Life Questionnaire score for the Internet and Usual care group as measured at 0, 3, 12, and 30 months of follow-up.
Figure 5
Figure 5
Mean Asthma Control Questionnaire score for the Internet and Usual care group as measured at 0, 3, 12, and 30 months of follow-up.
Figure 6
Figure 6
Mean ICS dosage for the Internet and Usual care group as measured at 0, 3, 12, and 30 months of follow-up.
Figure 7
Figure 7
Mean FEV1 for the Internet and Usual care group as measured at 0, 3, 12, and 30 months of follow-up.
See this image and copyright information in PMC

References

    1. Demoly P, Paggiaro P, Plaza V, Bolge SC, Kannan H, Sohier B, Adamek L. Prevalence of asthma control among adults in France, Germany, Italy, Spain and the UK. Eur Respir Rev. 2009 Jun;18(112):105–12. doi: 10.1183/09059180.00001209. http://err.ersjournals.com/cgi/pmidlookup?view=long&pmid=20956130 - DOI - PubMed
    1. British Thoracic Society. Scottish Intercollegiate Guidelines Network British guideline on the management of asthma. 2008. http://www.brit-thoracic.org.uk/Portals/0/Guidelines/AsthmaGuidelines/si.... - PubMed
    1. Global Initiative for Asthma (GINA) Global strategy for asthma management and prevention. 2012. [2013-01-21]. http://www.ginasthma.org/uploads/users/files/GINA_Report_2012.pdf.
    1. Rabe KF, Adachi M, Lai CK, Soriano JB, Vermeire PA, Weiss KB, Weiss ST. Worldwide severity and control of asthma in children and adults: the global asthma insights and reality surveys. J Allergy Clin Immunol. 2004 Jul;114(1):40–7. doi: 10.1016/j.jaci.2004.04.042. - DOI - PubMed
    1. Gibson PG, Powell H, Coughlan J, Wilson AJ, Abramson M, Haywood P, Bauman A, Hensley MJ, Walters EH. Self-management education and regular practitioner review for adults with asthma. Cochrane Database Syst Rev. 2003;(1):CD001117. doi: 10.1002/14651858.CD001117. - DOI - PubMed

Publication types

Substances

Associated data