Web-based management program benefits asthma patients
MedWire News: An internet-based self-management program can help improve asthma control for patients with the respiratory condition, research shows.
“Internet technology is increasingly seen as an appealing tool to support self-management for patients with chronic disease in remote and underserved populations,” explain Victor van der Meer (Leiden University Medical Center, The Netherlands) and team.
However, they add: “To date, studies on internet-based asthma self-management show only short-term improvements in asthma control, lung function, and quality of life. Long-term studies on the effect of internet-based self-management, including all its essential features, are not available.”
To address this, the team studied 200 adults with asthma from 37 Dutch general practices who had taken inhaled corticosteroids for at least 3 months during the previous year and who had access to the internet. Of these, 101 were assigned to internet-based self-management and 99 to usual care.
The internet-based self-management program, which was accessed through the specially designed website, provided weekly asthma control monitoring and treatment advice, use of an internet-based treatment plan, online education, and remote web communications with a specialist asthma nurse.
Asthma-related quality of life was measured at baseline and at 12 months using the Asthma Quality of Life Questionnaire (AQLQ). A clinically relevant improvement was defined as at least a 0.5-point increase on a 7-point scale, with higher scores indicating better quality of life.
Asthma control was also assessed at baseline and at 12 months using the Asthma Control Questionnaire (ACQ), with the minimal clinically significant improvement defined as a fall of 0.5 points on a 7-point scale, with higher scores indicating poorer control.
Over the study period, the researchers found that average asthma-related quality of life improved by 0.56 points on the AQLQ in the internet group compared with 0.18 points in the usual care group. Overall, 54% of patients in the internet group achieved an improvement of at least 0.50 points compared with just 27% of those in the usual care group.
Patients in the internet group also showed greater improvements in asthma control at 12 months than those in the usual care group, at a reduction of an average 0.54 points versus 0.06 points, respectively, on the ACQ. In total, 48% of patients in the internet group achieved an improvement of at least –0.50 points versus 17% of the usual care patients.
Furthermore, at 12 months, 63% of patients in the internet group reported symptom-free days in the previous 2 weeks compared with just 52% of usual care patients. Patients in the internet group also showed greater improvement in lung function than those in the usual care group.
However, there was no significant difference in exacerbations between the two groups over the study period, with 17 exacerbations occurring in 11 patients in the internet group and 20 exacerbations occurring in 10 patients in the usual care group.
Writing in the Annals of Internal Medicine, van der Meer and team conclude: “Internet-based self-management improves asthma-related quality of life, asthma control, and lung function and increases the number of symptom-free days.
“The challenge is implementing internet-based self-management on a wider scale within routine asthma care.”
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009
By Mark Cowen