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Internet-Based Program to Assist Patients in Asthma Care FREE

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The summary below is from the full report titled “Internet-Based Self-management Plus Education Compared With Usual Care in Asthma. A Randomized Trial.” It is in the 21 July 2009 issue of Annals of Internal Medicine (volume 151, pages 110-120). The authors are V. van der Meer, M.J. Bakker, W.B. van den Hout, K.F. Rabe, P.J. Sterk, J. Kievit, W.J.J. Assendelft, and J.K. Sont, for the SMASHING (Self-Management in Asthma Supported by Hospitals, ICT, Nurses and General Practitioners) Study Group.

Ann Intern Med. 2009;151(2):I-42. doi:10.7326/0003-4819-151-2-200907210-00001
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What is the problem and what is known about it so far?

Persons with asthma develop muscle contraction in the walls of the tubes that bring air to the lungs. Breathing is difficult when the airways contract. Some persons with asthma have infrequent symptoms, others have severe symptoms on most days, and most are somewhere in between. Triggers of asthma symptoms include smoke, infection, allergic reactions, cold weather, and exercise. In some persons, the triggers are unclear.

Fortunately, treatment of asthma is effective. Asthma drugs fall into 2 categories: drugs that control asthma over the long term, making attacks less frequent, and drugs that help during asthma attacks by relaxing the airways. Because asthma is a chronic condition, patient involvement in their own care is important to control the disease. Patients must understand the disease and its treatment, be aware of things that make it worse, and know how to monitor their own symptoms. The Internet might provide an opportunity to support patients in the self-management of asthma and other chronic conditions.

Why did the researchers do this particular study?

To find out whether an Internet-based program to assist patients in taking care of asthma would improve patient outcomes.

Who was studied?

200 adults with asthma.

How was the study done?

All patients received basic education about asthma, medications, the proper use of inhaled medications, and the use of a hand-held spirometer (a device to monitor how well the lungs were working). The researchers then randomly assigned patients to either usual care by their doctor or an Internet-based asthma program in addition to care by their doctor. The Internet program provided patients with a special Web site that allowed them to view treatment plans on the basis of their response to a questionnaire about asthma symptoms and to communicate with a nurse. The researchers collected information for 12 months about quality of life, asthma symptoms, asthma attacks, and lung function.

What did the researchers find?

At 12 months, patients in the Internet group reported improvements in asthma control and lung function compared with patients in the usual care group. However, the improvements in quality of life were minimal and the number of asthma attacks were not reduced.

What were the limitations of the study?

The study only lasted 12 months, and study patients knew which group they were in.

What are the implications of the study?

Modest improvements in some asthma outcomes are possible with an Internet-based program to help patients take care of themselves. However, the Internet program does not seem to reduce the number of asthma attacks.





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