Asthma diagnosis and treatment
Internet-based monitoring of asthma: A long-term, randomized clinical study of 300 asthmatic subjects

https://doi.org/10.1016/j.jaci.2005.03.030Get rights and content

Background

Experience from other fields of internal medicine shows that Internet-based technology can be used to monitor various diseases. The new technology handles complex calculation programs easily, and it is a unique way of communicating. These advantages might be used in optimizing the treatment for asthmatic subjects because undertreatment is a common problem found in European asthmatic subjects.

Objective

We sought to investigate the outcome of monitoring and treatment using a physician-managed online interactive asthma monitoring tool and to assess whether the outcome differs from that of monitoring and treatment in an outpatient respiratory clinic or in primary care.

Methods

Three hundred asthmatic subjects were randomized to 3 parallel groups in a 6-month prospective study: (1) Internet-based monitoring (n = 100); (2) specialist monitoring (n = 100); and (3) general practitioner (GP) monitoring (n = 100). All the patients were examined on entry into the study and after 6 months of treatment.

Results

The treatment and monitoring with the Internet-based management tool lead to significantly better improvement in the Internet group than in the other 2 groups regarding asthma symptoms (Internet vs specialist: odds ratio of 2.64, P = .002; Internet vs GP: odds ratio of 3.26; P < .001), quality of life (Internet vs specialist: odds ratio of 2.21, P = .03; Internet vs GP: odds ratio of 2.10, P = .04), lung function (Internet vs specialist: odds ratio of 3.26, P = .002; Internet vs GP: odds ratio of 4.86, P < .001), and airway responsiveness (Internet vs GP: odds ratio of 3.06, P = .02).

Conclusion

When physicians and patients used an interactive Internet-based asthma monitoring tool, better asthma control was achieved.

Section snippets

Study design

The study was carried out in a 6-month, prospective, randomized comparative design with 3 parallel groups and 2 scheduled visits 6 months apart. At each visit, questionnaires were filled in, spirometry was performed, measurement of airway responsiveness with methacholine was conducted, and each patient was interviewed by the physician. The patients were randomized consecutively by using the sealed envelope technique, irrespective of computer experience and smoking status, to one of the

Results

We enrolled 300 subjects who fulfilled the criteria for asthma. There were no significant differences among the 3 groups at baseline (Table I). Two hundred fifty-three subjects completed both the screening and follow-up visits. No significant difference was found in the dropout rate of the 3 groups (15, 12, and 20 subjects, respectively; P = .26, χ2).

Discussion

A Cochrane review27 demonstrates that asthma is better controlled if patients, self-monitoring their symptoms and peak flow, follow a written action plan and attend regular control visits to their physician's office. But it can be quite complicated to handle for both patients and physicians, and therefore Internet-based management systems have been developed to try to improve user-friendliness in self-management and monitoring.

This randomized controlled study is one of a very few similar

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    Supported by grants from H:S Corporation of University Hospital of Copenhagen, AstraZeneca, and private funds, none of whom had any role in writing the protocol; collecting, analyzing, or interpreting the data; or writing of the article.

    Disclosure of potential conflict of interest: A grant, managed by V. Backer, was given by AstraZeneca. K. Phanareth was employed as a consultant on an hourly basis by AstraZeneca DK during the first 2 years of the project, No other conflicts of interest are disclosed.

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