Internet-Based Self-management Plus Education Compared With Usual Care in Asthma

Annals of Internal Medicine 151(2):110-120, 21 July 2009 Victor van der Meer, MD; Moira J. Bakker, RN; Wilbert B. van den Hout, PhD; Klaus F. Rabe, MD, PhD; Peter J. Sterk, MD, PhD; Job Kievit, MD, PhD; Willem J.J. Assendelft, MD, PhD; and Jacob K. Sont, PhD, for the SMASHING (Self-Management in Asthma Supported by Hospitals, ICT, Nurses and General Practitioners) Study Group

Background: The Internet may support patient self-management of chronic conditions, such as asthma.

Objective: To evaluate the effectiveness of Internet-based asthma self-management.

Design: Randomized, controlled trial.

Setting: 37 general practices and 1 academic outpatient department in the Netherlands.

Patients: 200 adults with asthma who were treated with inhaled corticosteroids for 3 months or more during the previous year and had access to the Internet.

Measurements: Asthma-related quality of life at 12 months (minimal clinically significant difference of 0.5 on the 7-point scale), asthma control, symptom-free days, lung function, and exacerbations.

Intervention: Participants were randomly assigned by using a computer-generated permuted block scheme to Internet-based self-management (n = 101) or usual care (n = 99). The Internet-based self-management program included weekly asthma control monitoring and treatment advice, online and group education, and remote Web communications.

Results: Asthma-related quality of life improved by 0.56 and 0.18 points in the Internet and usual care groups, respectively (adjusted between-group difference, 0.38 [95% CI, 0.20 to 0.56]). An improvement of 0.5 point or more occurred in 54% and 27% of Internet and usual care patients, respectively (adjusted relative risk, 2.00 [CI, 1.38 to 3.04]). Asthma control improved more in the Internet group than in the usual care group (adjusted difference, –0.47 [CI, –0.64 to –0.30]). At 12 months, 63% of Internet patients and 52% of usual care patients reported symptom-free days in the previous 2 weeks (adjusted absolute difference, 10.9% [CI, 0.05% to 21.3%]). Prebronchodilator FEV1 changed with 0.24 L and –0.01 L for Internet and usual care patients, respectively (adjusted difference, 0.25 L [CI, 0.03 to 0.46 L]). Exacerbations did not differ between groups.

Limitation: The study was unblinded and lasted only 12 months.

Conclusion: Internet-based self-management resulted in improvements in asthma control and lung function but did not reduce exacerbations, and improvement in asthma-related quality of life was slightly less than clinically significant.

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