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
. 2013 Nov 27;2013(11):CD010013.
doi: 10.1002/14651858.CD010013.pub2.

Smartphone and tablet self management apps for asthma

José S Marcano Belisario  1 , Kit Huckvale, Geva Greenfield, Josip Car, Laura H Gunn
Affiliations

Smartphone and tablet self management apps for asthma

José S Marcano Belisario et al. Cochrane Database Syst Rev. .

Abstract

Background: Asthma is one of the most common long-term conditions worldwide, which places considerable pressure on patients, communities and health systems. The major international clinical guidelines now recommend the inclusion of self management programmes in the routine management of patients with asthma. These programmes have been associated with improved outcomes in patients with asthma. However, the implementation of self management programmes in clinical practice, and their uptake by patients, is still poor. Recent developments in mobile technology, such as smartphone and tablet computer apps, could help develop a platform for the delivery of self management interventions that are highly customisable, low-cost and easily accessible.

Objectives: To assess the effectiveness, cost-effectiveness and feasibility of using smartphone and tablet apps to facilitate the self management of individuals with asthma.

Search methods: We searched the Cochrane Airways Group Register (CAGR), the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, CINAHL, Global Health Library, Compendex/Inspec/Referex, IEEEXplore, ACM Digital Library, CiteSeer(x) and CAB abstracts via Web of Knowledge. We also searched registers of current and ongoing trials and the grey literature. We checked the reference lists of all primary studies and review articles for additional references. We searched for studies published from 2000 onwards. The latest search was run in June 2013.

Selection criteria: We included parallel randomised controlled trials (RCTs) that compared self management interventions for patients with clinician-diagnosed asthma delivered via smartphone apps to self management interventions delivered via traditional methods (e.g. paper-based asthma diaries).

Data collection and analysis: We used standard methods expected by the Cochrane Collaboration. Our primary outcomes were symptom scores; frequency of healthcare visits due to asthma exacerbations or complications and health-related quality of life.

Main results: We included two RCTs with a total of 408 participants. We found no cluster RCTs, controlled before and after studies or interrupted time series studies that met the inclusion criteria for this systematic review. Both RCTs evaluated the effect of a mobile phone-based asthma self management intervention on asthma control by comparing it to traditional, paper-based asthma self management. One study allowed participants to keep daily entries of their asthma symptoms, asthma medication usage, peak flow readings and peak flow variability on their mobile phone, from which their level of asthma control was calculated remotely and displayed together with the corresponding asthma self management recommendations. In the other study, participants recorded the same readings twice daily, and they received immediate self management feedback in the form of a three-colour traffic light display on their phones. Participants falling into the amber zone of their action plan twice, or into the red zone once, received a phone call from an asthma nurse who enquired about the reasons for their uncontrolled asthma.We did not conduct a meta-analysis of the data extracted due to the considerable degree of heterogeneity between these studies. Instead we adopted a narrative synthesis approach. Overall, the results were inconclusive and we judged the evidence to have a GRADE rating of low quality because further evidence is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. In addition, there was not enough information in one of the included studies to assess the risk of bias for the majority of the domains. Although the other included study was methodologically rigorous, it was not possible to blind participants or personnel in the study. Moreover, there are concerns in both studies in relation to attrition bias and other sources of bias.One study showed that the use of a smartphone app for the delivery of an asthma self management programme had no statistically significant effect on asthma symptom scores (mean difference (MD) 0.01, 95% confidence interval (CI) -0.23 to 0.25), asthma-related quality of life (MD of mean scores 0.02, 95% CI -0.35 to 0.39), unscheduled visits to the emergency department (OR 7.20, 95% CI 0.37 to 140.76) or frequency of hospital admissions (odds ratio (OR) 3.07, 95% CI 0.32 to 29.83). The other included study found that the use of a smartphone app resulted in higher asthma-related quality of life scores at six-month follow-up (MD 5.50, 95% CI 1.48 to 9.52 for the physical component score of the SF-12 questionnaire; MD 6.00, 95% CI 2.51 to 9.49 for the mental component score of the SF-12 questionnaire), improved lung function (PEFR) at four (MD 27.80, 95% CI 4.51 to 51.09), five (MD 31.40, 95% CI 8.51 to 54.29) and six months (MD 39.20, 95% CI 16.58 to 61.82), and reduced visits to the emergency department due to asthma-related complications (OR 0.20, 95% CI 0.04 to 0.99). Both studies failed to find any statistical differences in terms of adherence to the intervention and occurrence of other asthma-related complications.

Authors' conclusions: The current evidence base is not sufficient to advise clinical practitioners, policy-makers and the general public with regards to the use of smartphone and tablet computer apps for the delivery of asthma self management programmes. In order to understand the efficacy of apps as standalone interventions, future research should attempt to minimise the differential clinical management of patients between control and intervention groups. Those studies evaluating apps as part of complex, multicomponent interventions, should attempt to tease out the relative contribution of each intervention component. Consideration of the theoretical constructs used to inform the development of the intervention would help to achieve this goal. Finally, researchers should also take into account: the role of ancillary components in moderating the observed effects, the seasonal nature of asthma and long-term adherence to self management practices.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

1
1
PRISMA flow diagram.
2
2
PRISMA flow diagram ‐ June/July 2013 update
3
3
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
4
4
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Smartphone asthma apps versus control, Outcome 1 Symptom scores using the ACQ.
1.2
1.2. Analysis
Comparison 1 Smartphone asthma apps versus control, Outcome 2 Patients with unscheduled visits to the emergency department.
1.3
1.3. Analysis
Comparison 1 Smartphone asthma apps versus control, Outcome 3 Hospital admissions.
1.4
1.4. Analysis
Comparison 1 Smartphone asthma apps versus control, Outcome 4 GP consultations for asthma.
1.5
1.5. Analysis
Comparison 1 Smartphone asthma apps versus control, Outcome 5 Unscheduled general practice nurse consultation.
1.6
1.6. Analysis
Comparison 1 Smartphone asthma apps versus control, Outcome 6 Out of hours attendances.
1.7
1.7. Analysis
Comparison 1 Smartphone asthma apps versus control, Outcome 7 HRQoL measured on the SF‐12 questionnaire.
1.8
1.8. Analysis
Comparison 1 Smartphone asthma apps versus control, Outcome 8 HRQoL measured on the mini‐AQLQ.
1.9
1.9. Analysis
Comparison 1 Smartphone asthma apps versus control, Outcome 9 Proportion of participants adherent to the intervention.
1.10
1.10. Analysis
Comparison 1 Smartphone asthma apps versus control, Outcome 10 Healthcare costs.
1.11
1.11. Analysis
Comparison 1 Smartphone asthma apps versus control, Outcome 11 Peak expiratory flow rate (PEFR).
1.12
1.12. Analysis
Comparison 1 Smartphone asthma apps versus control, Outcome 12 Forced expiratory volume in 1 second (FEV1) percentage predicted.
1.13
1.13. Analysis
Comparison 1 Smartphone asthma apps versus control, Outcome 13 Proportion of participants experiencing at least one acute asthma exacerbation.
1.14
1.14. Analysis
Comparison 1 Smartphone asthma apps versus control, Outcome 14 Proportion of participants who required at least one course of steroids.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Liu 2011 {published data only (unpublished sought but not used)}
    1. Liu WT, Huang CD, Wang CH, Lee KY, Lin SM, Kuo HP. A mobile telephone‐based interactive self‐care system improves asthma control. European Respiratory Journal 2011;37(2):310‐7. [DOI: 10.1183/09031936.00000810] - DOI - PubMed
Ryan 2012 {published data only}
    1. Ryan D, Pinnock H, Lee AJ, Tarassenko L, Ayansina D, Musgrave S, et al. Can your mobile phone help your asthma: preliminary results. Primary Care Respiratory Journal 2010;19(2):A15.
    1. Ryan D, Pinnock H, Lee AJ, Tarassenko L, Pagliari C, Sheikh A, et al. The CYMPLA trial. Mobile phone‐based structured intervention to achieve asthma control in patients with uncontrolled persistent asthma: a pragmatic randomised controlled trial. Primary Care Respiratory Journal 2009;18(4):343‐45. [DOI: 10.4104/pcrj.2009.00064] - DOI - PMC - PubMed
    1. Ryan D, Price D, Musgrave SD, Malhotra S, Lee AJ, Ayansina D, et al. Clinical and cost effectiveness of mobile phone supported self monitoring of asthma: multicentre randomised controlled trial. BMJ 2012;344(e1756):1‐15. [DOI: 10.1136/bmj.e1756] - DOI - PMC - PubMed

References to studies excluded from this review

Al‐Dowaihi 2013 {published data only}
    1. Al‐Dowaihi D, Al‐Ajlan M, Al‐Zahrani N, Al‐Quwayfili N, al‐Jwiser N, Kanjo E. mBreath: Asthma Monitoring System on the Go. International Conference on Computer Medical Applications. January 2013. [DOI: 10.1109/ICCMA.2013.6506169] - DOI
Awoyinka 2011 {published data only}
    1. Awoyinka IA, Shanovich KK, Chih M, McTavish F, Sorkness C, Gustafson D. Perception of asthma control in overweight inner‐city teens. Journal of Allergy and Clinical Immunology 2011;127(2):AB267.
Bumatay 2012 {published data only}
    1. Bumatay A, Chan R, Lauher K, Kwan AM, Stoltz T, Delplanque JP, et al. Coupled mobile phone platform with peak flowmeter enables real‐time lung function assessment. IEEE Sensors Journal 2012;12(3):685‐91.
Burbank 2013 {published data only}
    1. Burbank AJ, Hall‐Barrow J, Denman RR, Lewis SD, Hewes M, Schellhase DE, et al. There's an app for that: a pilot and feasibility study of mobile‐based asthma action plans. Journal of Allergy and Clinical Immunology 2013;131(2):AB161.
Burnay 2013 {published data only}
    1. Burnay E, Cruz‐Correia R, Jacinto T, Sá Sousa A, Fonseca J. Challenges of a mobile application for asthma and allergic rhinitis patient enablement ‐ interface and synchronization. Telemedicine and e‐Health 2013;19(1):13‐8. - PubMed
Chiu 2011 {published data only}
    1. Chiu HW, Chen IJ, Hsieh YJ, Lee TC. G‐Asthma: A smart phone‐based asthma management system for Taiwanese. 5th European Conference of the Internation Federation for Medical and Biological Engineering. 2011:898‐901.
Chu 2006 {published data only}
    1. Chu HT, Huang CC, Lian ZH, Tsai JJP. A ubiquitous warning system for asthma‐inducement. Proceedings of the IEEE International Conference on Sensor Networks, Ubiquitous, and Trustworthy Computing (SUTC '06). 2006:186‐91.
Cleland 2007 {published data only}
    1. Cleland J, Caldow J, Ryan D. A qualitative study of the attitudes of patients and staff to the use of mobile phone technology for recording and gathering asthma data. Journal of Telemedicine and Telecare 2007;13:85‐9. [DOI: 10.1258/135763307780096230] - DOI - PubMed
Finkelstein 2002 {published data only}
    1. Finkelstein J, Nambu S, Khare R, Gupta D. CO‐ED: A development platform for interactive patient education. Proceedings of the International Conference on Computers in Education. 2002.
Finkelstein 2009 {published data only}
    1. Finkelstein J, Wood J. Mobile eLearning platform for interactive patient education. 2009 International Conference on Mobile, Hybrid, and On‐line Learning. 2009:23‐7. [DOI: 10.1109/eLmL.2009.24] - DOI
Glykas 2004 {published data only}
    1. Glykas M, Chytas P. Technological innovations in asthma patient monitoring and care. Expert Systems with Applications 2004;27:121‐31. [DOI: 10.1016/j.eswa.2003.12.007] - DOI
Gupta 2011A {published data only}
    1. Gupta S, Chang P, Anyigbo N, Sabharwal A. mobileSpiro: Portable open‐interface spirometry for Android. Proceedings of the 2nd Conference on Wireless Health. 2011:Article No. 24.
Gupta 2011B {published data only}
    1. Gupta S, Chang P, Anyigbo N, Sabharwal A. mobileSpiro: Accurate mobile spirometry for self‐management of asthma. Proceedings of the First ACM Workshop on Mobile Systems, Applications, and Services for Healthcare. 2011:Article No. 1.
Holtz 2009 {published data only}
    1. Holtz B, Whitten P. Managing asthma with mobile phones: a feasibility study. Telemedicine and e‐Health 2009;15(9):907‐9. [DOI: 10.1089/tmj.2009.0048] - DOI - PubMed
Larson 2013 {published data only}
    1. Larson EC, Goel M, Redfield M, Boriello G, Rosenfeld M, Patel SN. Tracking lung function on any phone. Proceedings of the 3rd ACM Symposium on Computing for Development. 2013.
Lee 2005 {published data only}
    1. Lee HR, Yoo SK, Jung SM, Kwon NY, Hong CS. A web‐based mobile asthma management system. Journal of Telemedicine and Telecare 2005;11(Suppl 1):56‐9. - PubMed
Licskai 2011 {published data only}
    1. Licskai C, Sands T, Ferrone M. Integrating the air quality health index into asthma action plans. American Journal of Respiratory Critical Care Medicine 2011;183:A4767.
Lim 2009 {published data only}
    1. Lim T, Kong M, Lim F, Chee M, Tan L, Tan K. A pilot project of inhaler technique in the multimedia format for asthma education. Journal of Allergy and Clinical Immunology 2009;123(2):S65.
Lin 2009 {published data only}
    1. Lin SP, Yang HY. Exploring key factors in the choice of e‐health using an asthma care mobile service model. Telemedicine and e‐Health 2009;2009:884‐90. - PubMed
Oletic 2012 {published data only}
    1. Oletic D, Arsenali B, Bilas V. Towards continuous wheeze detection body sensor node as a core of asthma monitoring system. Wireless Mobile Communication and Healthcare. Springer, 2012.
Pinnock 2006 {published data only}
    1. Pinnock H, Slack R, Pagliari C, Price D, Sheikh A. Professional and patient attitudes to using mobile phone technology to monitor asthma: questionnaire survey. Primary Care Respiratory Journal 2006;15:237‐45. - PMC - PubMed
Pinnock 2007 {published data only}
    1. Pinnock H, Slack R, Pagliari C, Price D, Sheikh A. Understanding the potential role of mobile phone‐based monitoring on asthma self‐management: qualitative study. Clinical and Experimental Allergy 2007;37:794‐802. - PubMed
Postolache 2009 {published data only}
    1. Postolache O, Girão P, Dias Pereira M, Ferraria G, Barroso N. Indoor monitoring of respiratory distress triggering factors using a wireless sensing network and smart phone. International Instrumentation and Measurement Technology Conference. 2009.
Ryan 2005 {published data only}
    1. Ryan D, Cobern W, Wheeler J, Price D, Tarassenko L. Mobile phone technology in the management of asthma. Journal of Telemedicine and Telecare 2005;11(Suppl 1):43‐6. - PubMed
Sundberg 2005 {published data only}
    1. Sundberg R, Tunsäter A, Palmqvist M, Ellbjär S, Löwhagen O, Torén K. A randomized controlled study of a computerized limited education program among young adults with asthma. Respiratory Medicine 2005;99:321‐8. - PubMed

Additional references

Baron 2012
    1. Baron J, McBain H, Newman S. The impact of mobile monitoring technologies on glycosylated hemoglobin in diabetes: a systematic review. Journal of Diabetes Science & Technology 2012;6(5):1185‐96. - PMC - PubMed
Boyd 2009
    1. Boyd M, Lasserson TJ, McKean MC, Gibson PG, Ducharme FM, Haby M. Interventions for educating children who are at risk of asthma‐related emergency department attendance. Cochrane Database of Systematic Reviews 2009, Issue 2. [DOI: 10.1002/14651858.CD001290.pub2] - DOI - PMC - PubMed
Braman 2006
    1. Braman SS. The global burden of asthma. Chest 2006;130(1):4S‐12S. - PubMed
BTS‐SIGN 2011
    1. British Thoracic Society ‐ Scottish Intercollegiate Guideline Network. British guideline on the management of asthma: a national clinical guideline. www.sign.ac.uk/guidelines/fulltext/101/index.html (accessed November 2011).
Bussey‐Smith 2007
    1. Bussey‐Smith KL, Rossen RD. A systematic review of randomized control trials evaluating the effectiveness of interactive computerized asthma patient education programs. Annals of Allergy, Asthma and Immunology 2007;98(6):507‐16. - PubMed
Charles 2007
    1. Charles T, Quinn D, Weatherall M, Aldington S, Beasley R, Holt S. An audiovisual reminder function improves adherence with inhaled corticosteroid therapy in asthma. Journal of Allergy and Clinical Immunology 2007;119(4):811‐6. - PubMed
Creer 2008
    1. Creer TL. Behavioral and cognitive processes in the self‐management of asthma. Journal of Asthma 2008;45:81‐94. [DOI: 10.1080/02770900701247236] - DOI - PubMed
Department of Health 2006
    1. Department of Health. Supporting people with long term conditions to self care ‐ a guide to developing local strategies and good practice. Department of Health 2006.
EndNote [Computer program]
    1. Thomson Reuters Corporation. EndNote. New York, USA: Thomson Reuters Corporation, 2010.
EPOC 2009
    1. Cochrane Effective Practice and Organization of Care (EPOC) Review Group. Data collection checklist. http://epoc.cochrane.org/sites/epoc.cochrane.org/files/uploads/datacolle... (accessed March 2012).
Estrin 2010
    1. Estrin D, Sim I. Health care delivery. Open mHealth architecture: an engine for health care innovation. Science 2010;330(6005):759‐60. - PubMed
Fleming 2000
    1. Flaming DM, Cross KW, Sunderland R, Ross AM. Comparison of the seasonal patterns of asthma identified in general practitioner episodes, hospital admissions, and deaths. Thorax 2000;55:662‐5. [DOI: 10.1136/thorax.55.8.662] - DOI - PMC - PubMed
Foster 2007
    1. Foster G, Taylor SJC, Eldridge S, Ramsay J, Griffiths CJ. Self‐management education programmes by lay leaders for people with chronic conditions. Cochrane Database of Systematic Reviews 2007, Issue 4. [DOI: 10.1002/14651858.CD005108.pub2] - DOI - PubMed
Gibson 2008
    1. Gibson PG, Powell H, Wilson A, Hensley MJ, Abramson MJ, Bauman A, et al. Limited (information only) patient education programs for adults with asthma. Cochrane Database of Systematic Reviews 2008, Issue 4. [DOI: 10.1002/14651858.CD001005] - DOI - PubMed
Gibson 2009
    1. Gibson PG, Powell H, Wilson A, Abramson MJ, Haywood P, Bauman A, et al. Self‐management education and regular practitioner review for adults with asthma. Cochrane Database of Systematic Reviews 2009, Issue 3. [DOI: 10.1002/14651858.CD001117] - DOI - PubMed
GINA 2011
    1. Global Initiative for Asthma. Global strategy for asthma management and prevention. http://www.ginasthma.org/uploads/users/files/GINA_Report2011_May4.pdf (accessed 19 December 2012).
Haughney 2004
    1. Haughney J, Barnes G, Partridge M, Cleland J. The Living & Breathing Study: a study of patients' views of asthma and its treatment. Primary Care Respiratory Journal 2004;13:28‐35. [DOI: 10.1016/j.pcrj.2003.11.007] - DOI - PMC - PubMed
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Huckvale 2012
    1. Huckvale K, Car M, Morrison C, Car J. Apps for asthma self‐management: a systematic assessment of content and tools. BMC Medicine 2012;10:144. [DOI: 10.1186/1741-7015-10-144] - DOI - PMC - PubMed
Istepanian 2005
    1. Istepanian R, Laxminarayan S, Pattichis CS (editors). M‐Health: Emerging Mobile Health Systems. Springer, 2005.
Juniper 1999
    1. Juniper EF, O'Byrne PM, Guyatt GH, Ferrie PJ, King DR. Development and validation of a questionnaire to measure asthma control. European Respiratory Journal 1999;14(4):902‐7. - PubMed
Kaya 2009
    1. Kaya Z, Erkan F, Ozkan M, Ozkan S, Kocaman M, Ertekin BA, et al. Self‐management plans for asthma control and predictors of patient compliance. Journal of Asthma 2009;46:270‐5. - PubMed
Lahdensuo 1999
    1. Lahdensuo A. Guided self‐management of asthma ‐ how to do it?. BMJ 1999;319(7212):759‐60. - PMC - PubMed
MacLeod 2013
    1. MacLeod H, Feldman R. Tablets to nearly double in 2013. http://yougov.co.uk/news/2012/09/11/tablets‐nearly‐double‐2013/ 11 September 2013 (accessed 10 October 2013).
Masoli 2004
    1. Masoli M, Fabian D, Holt S, Beasley R. The global burden of asthma: executive summary of the GINA Dissemination Committee Report. Allergy 2004;59(5):469‐78. - PubMed
McLean 2010
    1. McLean S, Chandler D, Nurmatov U, Liu J, Pagliari C, Car J, et al. Telehealthcare for asthma. Cochrane Database of Systematic Reviews 2010, Issue 10. [DOI: 10.1002/14651858.CD007717.pub2] - DOI - PMC - PubMed
mHealth Alliance 2010
    1. Glossary of terms. www.mhealthalliance.org/media_center/glossary‐terms (accessed January 2012).
mobiThinking 2013
    1. Global mobile statistics 2013 Part A: Mobile subscribers; handset market share; mobile operators. http://mobithinking.com/mobile‐marketing‐tools/latest‐mobile‐stats/a#mob... (accessed 10 October 2013).
Mosa 2012
    1. Mosa ASM, Yoo I, Sheets L. A systematic review of healthcare applications for smartphones. BMC Medical Informatics and Decision Making 2012;12:67. [DOI: 10.1186/1472-6947-12-67] - DOI - PMC - PubMed
Newman 2010
    1. Serlachius A, Sutton S. Self‐management and behaviour change: theoretical models. In: Newman S, Steed L, Mulligan K editor(s). Chronic Physical Illness: Self‐Management and Behavioural Interventions. McGraw Hill, 2010.
NHLBI 2007
    1. National Heart, Lung and Blood Institute & National Asthma Education and Prevention Program. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf (accessed 19 December 2012).
NIH 2010
    1. National Institute of Health. What is complementary and alternative medicine?. www.nccam.nih.gov/health/whatiscam/ (accessed 2 December 2011).
Ofcom 2010
    1. Ofcom. Communications Market Report. www.stakeholders.ofcom.org.uk/market‐data‐research/market‐data/communica... (accessed January 2012).
Ofcom 2013
    1. Ofcom. Communications Market Report 2013. http://stakeholders.ofcom.org.uk/binaries/research/cmr/cmr13/2013_UK_CMR... 2013 (accessed 10 October 2013).
Partridge 2008
    1. Partridge MR, Caress AL, Brown C, Hennings J, Luker K, Woodcock A, et al. Can lay people deliver asthma self‐management education as effectively as primary care based practice nurses?. Thorax 2008;63(9):778‐83. - PubMed
Partridge 2011
    1. Partridge MR, Dal Negro RW, Olivieri D. Understanding patients with asthma and COPD: insights from a European study. Primary Care Respiratory Journal 2011;20(3):315‐23. [DOI: 10.4104/pcrj.2011.00056] - DOI - PMC - PubMed
Paré 2007
    1. Paré G, Jaana M, Sicotte C. Systematic review of home telemonitoring for chronic diseases: the evidence base. Journal of the American Medical Informatics Association 2007;14(3):269‐77. - PMC - PubMed
Pearce 2000
    1. Pearce N, Sunyer J, Cheng S, Chinn S, Bjorksten B, Burr M, et al. Comparison of asthma prevalence in the ISAAC and the ECRHS. European Respiratory Journal 2000;16(3):420‐6. - PubMed
Powell 2009
    1. Powell H, Gibson PG. Options for self‐management education for adults with asthma. Cochrane Database of Systematic Reviews 2009, Issue 3. [DOI: 10.1002/14651858.CD004107] - DOI - PMC - PubMed
RevMan 2011 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.1. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2011.
Ring 2007
    1. Ring N, Malcolm C, Wyke S, MacGillivray S, Dixon D, Hoskins G, et al. Promoting the use of Personal Asthma Action Plans: a systematic review. Primary Care Respiratory Journal 2007;16(5):271‐83. [DOI: 10.3132/pcrj.2007.00049] - DOI - PMC - PubMed
Ring 2011
    1. Ring N, Jepson R, Hoskins G, Wilson C, Pinnock H, Sheikh A, et al. Understanding what helps or hinders asthma action plan use: a systematic review and synthesis of the qualitative literature. Patient Education and Counseling 2011;85(2):131‐43. [DOI: 10.1016/j.pec.2011.01.025] - DOI - PubMed
Rodgers 2009
    1. Rodgers M, Sowden A, Petticrew M, Arai L, Roberts H, Britten N, et al. Testing methodological guidance on the conduct of narrative synthesis in systematic reviews: effectiveness of interventions to promote smoke alarm ownership and function. Evaluation 2009;15(1):49‐73.
Ryan 2011
    1. Ryan R. Guide for review authors on assessing study quality. Cochrane Consumers and Communication Review Group Study Quality Guide. http://www.latrobe.edu.au/chcp/assets/downloads/StudyQualityGuide_May201... (accessed March 2012).
Sanders 2006
    1. Sanders DL, Aronsky D. Biomedical informatics applications for asthma care: a systematic review. Journal of the American Medical Informatics Association 2006;13(4):418‐27. - PMC - PubMed
Smith 2013
    1. Smith A. Smartphone ownership ‐ 2013 update. http://pewinternet.org/˜/media//Files/Reports/2013/PIP_Smartphone_adopti... 5 June2013 (accessed 10 October 2013).
Tapp 2007
    1. Tapp S, Lasserson TJ, Rowe B. Education interventions for adults who attend the emergency room for acute asthma. Cochrane Database of Systematic Reviews 2007, Issue 3. [DOI: 10.1002/14651858.CD003000.pub2] - DOI - PMC - PubMed
Terry 2010
    1. Terry M. Medical apps for smartphones. Telemedicine Journal and e‐Health 2010;16(1):17‐22. - PubMed
Thomas 2008
    1. Thomas J, Harden A. Methods for thematic synthesis of qualitative research in systematic reviews. BMC Medical Research Methodology 2008;8:45. [DOI: 10.1186/1471-2288-8-45] - DOI - PMC - PubMed
Van der Meer 2009
    1. Meer V, Bakker MJ, Hout WB, Rabe KF, Sterk PJ, Kievit J, et al. Internet‐based self‐management plus education compared with usual care in asthma: a randomized trial. Annals of Internal Medicine 2009;151(2):110‐20. - PubMed
Verschelden 1996
    1. Verschelden P, Cartier A, L'Archeveque J, Trudeau C, Malo JL. Compliance with and accuracy of daily self‐assessment of peak expiratory flows (PEF) in asthmatic subjects over a three month period. European Respiratory Journal 1996;9:880‐5. - PubMed
Weinstein 2005
    1. Weinstein AG. Should patients with persistent severe asthma be monitored for medication adherence. Annals of Allergy, Asthma and Immunology 2005;94(2):251‐7. - PubMed
Welsh 2011
    1. Welsh EJ, Hasan M, Li P. Home‐based educational interventions for children with asthma. Cochrane Database of Systematic Reviews 2011, Issue 10. [DOI: 10.1002/14651858.CD008469.pub2] - DOI - PMC - PubMed
WHO 2011
    1. World Health Organization. Asthma, Fact sheet N°307. www.who.int/mediacentre/factsheets/fs307/en/index.html (accessed 14 February 2011).
Wilson 2010
    1. Wilson SR, Strub P, Buist AS, Knowles SB, Lavori PW, Lapidus J, et al. Shared treatment decision making improves adherence and outcomes in poorly controlled asthma. American Journal of Respiratory and Critical Care Medicine 2010;181(6):566‐77. - PMC - PubMed
Wolf 2008
    1. Wolf F, Guevara JP, Grum CM, Clark NM, Cates CJ. Educational interventions for asthma in children. Cochrane Database of Systematic Reviews 2008, Issue 4. [DOI: 10.1002/14651858.CD000326] - DOI - PubMed
Wu 2010
    1. Wu TY, Majeed A, Kuo KN. An overview of the healthcare system in Taiwan. London Journal of Primary Care 2010;3:115‐9. - PMC - PubMed
Zeldes 2005
    1. Zeldes N. The first PDA. www.nzeldes.com/HOC/Newton.htm (accessed 6 September 2011).
Zickuhr 2013
    1. Zickuhr K. Tablet ownership 2013. http://www.pewinternet.org/˜/media//Files/Reports/2013/PIP_Tablet%20owne... 10 June 2013 (accessed 10 October 2013).

Publication types