The challenge of recruiting in primary care for a trial of telemonitoring in asthma: an observational study Clinical and cost effectiveness of mobile phone supported self monitoring of asthma: multicentre randomised controlled trial A mobile phone short message service improves perceived control of asthma: a randomized controlled trial. A mobile telephone-based interactive self-care system improves asthma control Long-Term Outcomes of Internet-Based Self-Management Support in Adults With Asthma: Randomized Controlled Trial The use of text messaging to improve asthma control: a pilot study using the mobile phone short messaging service (SMS) Feasibility of Collecting Diary Data From Asthma Patients Through Mobile Phones and SMS (Short Message Service): Response Rate Analysis and Focus Group Evaluation From a Pilot Study Improving asthma control through telemedicine: a study of short-message service. Asthma patients are willing to use mobile and web technologies to support self‐management The “physician on call patient engagement trial” (POPET): measuring the impact of a mobile patient engagement application on health outcomes and quality of life in allergic rhinitis and asthma patients Reevaluation of Diagnosis in Adults With Physician-Diagnosed Asthma Internet-Based Self-management Plus Education Compared With Usual Care in Asthma A daily SMS reminder increases adherence to asthma treatment: a three-month follow-up study. Telehealth to improve asthma control in pregnancy: A randomized controlled trial.
Aim Achieving target recruitment in r and omized controlled trials ( RCTs ) is challenging . This paper compares our experience of recruiting for an RCT with the predictions made in our proposal . Methods Participating UK primary care practice s search ed their computer data bases  to identify patients ( 12 years and over ) with asthma who may be poorly controlled . Postal invitations were sent to all patients identified . Respondees were prescreened by phone , to assess their asthma control and establish their mobile phone suitability . Potentially eligible patients were booked for a trial recruitment visit . Results We recruited 288 patients ( 2.4 % of those invited ) across 32 practice s , with a total list size of 311,926 patients . This compares to our predicted recruitment of 312 patients from a population of 72,000 patients in six to eight practice s. In addition to the recognized problem of poor response rates , the major challenges were insufficiently discriminating computer search es and incompatibilities between mobile phone h and sets , networks and the asthma application . Conclusion Our data have implication s for clinicians , managers , and research ers in primary care . Research ers in this area may wish to consider our data when design ing their recruitment strategies . Improved coding of asthma morbidity data in clinical practice would ease identification of poorly controlled patients , both for clinical interventions and recruitment to trials . If telehealth is to become mainstream , there needs to be st and ardization of applications , operating platforms , and network capabilities Objective To determine whether mobile phone based monitoring improves asthma control compared with st and ard paper based monitoring strategies . Design Multicentre r and omised controlled trial with cost effectiveness analysis . Setting UK primary care . Participants 288 adolescents and adults with poorly controlled asthma ( asthma control question naire ( ACQ ) score ≥1.5 ) from 32 practice s. Intervention Participants were central ly r and omised to twice daily recording and mobile phone based transmission of symptoms , drug use , and peak flow with immediate feedback prompting action according to an agreed plan or paper based monitoring . Main outcome measures Changes in scores on asthma control question naire and self efficacy ( knowledge , attitude , and self efficacy asthma question naire ( KASE-AQ ) ) at six months after r and omisation . Assessment of outcomes was blinded . Analysis was on an intention to treat basis . Results There was no significant difference in the change in asthma control or self efficacy between the two groups ( ACQ : mean change 0.75 in mobile group v 0.73 in paper group , mean difference in change −0.02 ( 95 % confidence interval −0.23 to 0.19 ) ; KASE-AQ score : mean change −4.4 v −2.4 , mean difference 2.0 ( −0.3 to 4.2 ) ) . The numbers of patients who had acute exacerbations , steroid courses , and unscheduled consultations were similar in both groups , with similar healthcare costs . Overall , the mobile phone service was more expensive because of the expenses of telemonitoring . Conclusions Mobile technology does not improve asthma control or increase self efficacy compared with paper based monitoring when both groups received clinical care to guidelines st and ards . The mobile technology was not cost effective . Trial registration Clinical Trials NCT00512837 OBJECTIVE Mobile phone short message service ( SMS ) has been suggested as a potentially powerful tool to improve asthma outcomes , and it can overcome external barriers such as time and distance to participate education programs . We wanted to know whether SMS can help to overcome intrinsic barriers such as perceived control of asthma ( PCA ) . SUBJECTS AND METHODS One hundred fifty out patients with asthma were r and omly assigned to the control , traditional , and SMS groups . Patients in all groups received verbal education based on the Global Initiative for Asthma , and patients in the traditional group received additional individualized asthma action plan for self-management with peak expiratory flow monitoring and recording asthma diary , while patients in the SMS group received additional daily SMS reminders on their mobile phone . The six-item PCA Question naire ( PCAQ-6 ) , St and ard Asthma-Specific Quality of Life [ AQLQ(S ) ] , spirometry , blood and induced sputum cell count , follow-up compliance rate , medicine compliance rate , and emergency department ( ED ) visits data were collected at the initial visit and at 12 weeks . RESULTS In total , 71 participants completed the trial for analysis .  Patients ' PCAQ-6 score was significantly increased in the SMS and traditional groups ( p<0.001 ) after 12 weeks , and the change of patients ' PCAQ-6 score in the SMS group was higher than in the traditional group ( p=0.018 ) . Patients in the SMS group had the highest AQLQ(S ) score and follow-up rate after 12 weeks . The change in PCAQ-6 score was associated with change in AQLQ(S ) score ( r=0.442 ) . Patients in all groups had better forced expiratory volume in 1 s ( FEV1 % ) and fewer ED visits after 12 weeks , but no significant differences were found among the three groups in the changes of FEV1 % and blood and induced sputum eosinophil counts and neutrophil counts . CONCLUSIONS SMS can improve PCA , and it has a greater advantage in improving follow-up rate and asthma-specific quality of life than traditional programs The self-management of asthma can improve clinical outcomes . Recently , mobile telephones have been widely used as an efficient , instant personal communication tool . This study investigated whether a self-care system will achieve better asthma control through a mobile telephone-based interactive programme . This was a prospect i ve , controlled study in outpatient clinics . From 120 consecutive patients with moderate-to-severe persistent asthma , 89 were eventually recruited for the study , with 43 in the mobile telephone group ( with a mobile telephone-based interactive asthma self-care system )  . In the mobile telephone group , mean±sem peak expiratory flow rate significantly increased at 4 ( 378.2±9.3 L·min−1 ; n = 43 ; p = 0.020 ) , 5 ( 378.2±9.2 L·min−1 ; n = 43 ; p = 0.008 ) and 6 months ( 382.7±8.6 L·min−1 ; n = 43 ; p = 0.001 ) compared to the control group . Mean±sem forced expiratory volume in 1 s significantly increased at 6 months ( 65.2±3.2 % predicted ; n = 43 ; p<0.05 ) . Patients in the mobile telephone group had better quality of life after 3 months , as determined using the Short Form-12 ® physical component score , and fewer episodes of exacerbation and unscheduled visits than the control group . Patients in the mobile telephone group significantly increased their mean daily dose of either systemic or inhaled corticosteroids compared with the control group . The mobile telephone-based interactive self-care system provides a convenient and practical self-monitoring and -management of asthma , and improves asthma control Background Long-term asthma management falls short of the goals set by international guidelines . The Internet is proposed as an attractive medium to support guided self-management in asthma . Recently , in a multicenter , pragmatic r and omized controlled parallel trial with a follow-up period of 1 year , patients were allocated Internet-based self-management ( IBSM ) support ( Internet group [ IG ] ) or usual care ( UC ) alone . IBSM support was automatically terminated after 12 months of follow-up . In this study , IBSM support has been demonstrated to improve asthma-related quality of life , asthma control , lung function , and the number of symptom-free days as compared to UC . IBSM support was based on known key components for effective self-management and included weekly asthma control monitoring and treatment advice , online and group education , and communication ( both online and offline ) with a respiratory nurse . Objective The objective of the study was to assess the long-term effects of providing patients 1 year of IBSM support as compared to UC alone . Methods Two hundred adults with physician-diagnosed asthma ( 3 or more months of inhaled corticosteroids prescribed in the past year ) from 37 general practice s and 1 academic outpatient department who previously participated were invited by letter for additional follow-up at 1.5 years after finishing the study . The Asthma Control Question naire ( ACQ ) and the Asthma Quality of Life Question naire ( AQLQ ) were completed by 107 participants ( 60 UC participants and 47 IG participants ) . A minimal clinical important difference in both question naires is 0.5 on a 7-point scale . Results At 30 months after baseline , a sustained and significant difference in terms of asthma-related quality of life of 0.29 ( 95 % CI 0.01 - 0.57 ) and asthma control of -0.33 ( 95 % CI -0.61 to -0.05 ) was found in favor of the IBSM group . No such differences were found for inhaled corticosteroid dosage or for lung function , measured as forced expiratory volume in 1 second . Conclusions Improvements in asthma-related quality of life and asthma control were sustained in patients who received IBSM support for 1 year , even up to 1.5 years after terminating support . Future research should be focused on implementation of IBSM on a wider scale within routine asthma care . Trial Registration International St and ard R and omized Controlled Trial Number ( IS RCT N ) : 79864465 ; http://www.controlled-trials.com/IS RCT N79864465 ( Archived by WebCite at http://www.webcitation.org/6J4VHhPk4 ) We have evaluated the feasibility of using the mobile phone short message service ( SMS ) for symptom monitoring in patients with asthma . All consecutive patients admitted to hospital for asthma during an 11-month period were considered for enrolment ( n = 497 ) . Those meeting the inclusion criteria were r and omized into a control ( n = 60 ) and intervention group ( n = 60 ) . Patients in the intervention group received SMS messages according to a structured workflow , while patients in the control group had no SMS support . In the intervention group , the mean response rate to the messages was 82 % . There was an improvement in the Asthma Control Test ( ACT ) scores in 36 subjects in the intervention group compared to 28 subjects in the control group . There were reductions in the number of nebulizations in 54 subjects in the control group compared to 50 subjects in the intervention group , and reductions in emergency department visits in 57 subjects in the control group compared to 51 subjects in the intervention group . However , none of these differences were significant . There was no reduction in admission rates in either group ( P = 0.5 ) . The service was accepted by most patients , but its long-term effectiveness on the management of asthma remains to be determined Background Self-management of asthma may improve asthma outcomes . The Internet has been suggested as a tool for the monitoring and self-management of asthma . However , in a recent study we found that a Web interface had some disadvantages and that users stopped using the application after a short while . Objective The primary objective of this study was to evaluate , from a user perspective , the feasibility of using short message service ( SMS ) for asthma diary data collection through mobile phones . The secondary objective was to investigate patient compliance with an  SMS diary  , as measured by response rates over time . Methods The study included quantitative response rate data , based on SMS collection , and qualitative data from a traditional focus group setting . In a period of 2 months , the participants received 4 SMS messages each day , including a medication reminder , a request to enter peak flow , data on sleep loss , and medication dosage . Participants were asked to reply to a minimum of 3 of the messages per day . Diary inputs were collected in a data base and the response rate per patient was expressed as the number of diary inputs ( SMS replies ) divided by diary requests ( product of number of days in the study and the number of diary questions per day ) for each participant . After the study period , the participants were invited to a focus group interview addressing the participants ' attitudes to their disease , their experience with the SMS asthma diary , and their future expectations from the SMS asthma diary . Results Twelve patients with asthma ( 6 males , 6 females ) participated in the data collection study . The median age was 38.5 ( range : 13 – 57 ) years . The median response rate per patient was 0.69 ( range : 0.03 – 0.98 ) , ie , half the participants reported more than about two thirds of the requested diary data . Furthermore , response rates were relatively steady during the study period with no signs of decreasing usage over time . From the subsequent focus group interview with 9 users we learned that , in general , the participants were enthusiastic about the SMS diary – it became an integrated part of their everyday life . However , the participants wished for a simpler diary with only one SMS message to respond to and a system with a Web interface for system customization and graphical display of diary data history . Conclusion This study suggests that SMS collection of asthma diary data is feasible , and that SMS may be a tool for supporting the self-management of asthma ( and possibly other chronic diseases ) in motivated and self-efficacious patients because mobile phones are a part of people 's everyday lives and enable active requests for data wherever the patient is . The combination of SMS data collection and a traditional Web page for data display and system customization may be a better and more usable tool for patients than the use of Web-based asthma diaries which suffer from high attrition rates Home peak expiratory flow ( PEF ) measurement is recommended by asthma guidelines . In a 16-week r and omized controlled study on 16 subjects with asthma ( 24.6 6.5 years old , asthma duration small ze , Cyrillic 6 months ) , we examined Global System for Mobile Communications ( GSM ) mobile telephone short-message service ( SMS ) as a novel means of telemedicine in PEF monitoring . All subjects received asthma education , self-management plan , and st and ard treatment . All measured PEF three times daily and kept a symptom diary . In the study group , therapy was adjusted weekly by an asthma specialist according to PEF values received daily from the patients . There was no significant difference between the groups in absolute PEF , but PEF variability was significantly smaller in the study group ( 16.12 + /- 6.93 % vs. 27.24 + /- 10.01 % , p = 0.049 ) . forced expiratory flow in 1 second ( FEV1 ; % predicted ) in the study group was slightly but significantly increased ( 81.25 + /- 17.31 vs. 77.63 + /- 14.80 , p = 0.014 ) and in the control group , unchanged ( 78.25 + /- 21.09 vs. 78.88 + /- 22.02 , p = 0.497 ) . Mean FEV1 was similar in the two groups both before and after the study . Controls had significantly higher scores for cough ( 1.85 + /- 0.43 vs. 1.42 + /- 0.28 , p < 0.05 ) and night symptoms ( 1.22 + /- 0.23 vs. 0.85 + /- 0.32 , p < 0.05 ) . There was no significant difference between the groups in daily consumption of inhaled medicine , forced vital capacity , or compliance . Per patient , per week , the additional cost of follow-up by SMS was Euros 1.67 ( equivalent to approximately $ 1.30 per 1 Euro ) , and SMS transmission required 11.5 minutes . Although a study group of 40 patients is needed for the follow-up study to achieve the power of 80 % within the 95 % confidence interval , we conclude that SMS is a convenient , reliable , affordable , and secure means of telemedicine that may improve asthma control when added to a written action plan and st and ard follow-up Practical problems and patients or doctors low compliance has been hampering a wider use of self-management in asthma . Mobile or web technologies for supporting selfmanagement may improve patient – doctor communication and patient self-efficacy ( 1 , 2 ) . Furthermore , recent evidence suggests that interactive Internet-based asthma monitoring improves asthma control ( 3 ) . However , patients may not be willing to use a web asthma diary for more than short periods , possibly because it does not fit into their everyday lives ( 4 ) . The use of mobile phones has been suggested to overcome this problem ( 4 , 5 ) , but , to our knowledge , no data are available on the willingness of patients to use mobile phones , and very few data have been reported on their willingness to use the web for asthma self-management ( 6 ) . In the framework of a running r and omized controlled trial on psycho-educational interventions in asthma , 74 adults with moderate to severe asthma were r and omly allocated to fill a symptoms diary for 1 month . Of these , 37 dropped-out of the trial and the remaining 47 ( 63 % ) completed a self-administered question naire about asthma monitoring . These two groups did not differ significantly regarding age , education , socio-economic status , and asthma severity . Approximately one-third was younger than 31 years and half was older than 40 years ; 84 % were female ; nearly 70 % had low socio-economic background ( class IV and V ) and 44 % had 5 or fewer years of formal education .  FEV1 predicted % was below 80 % in 53 % , while 64 % were treated with high-dose inhaled steroids . During the previous year , 56 % had at least one exacerbation requiring oral steroids and one in five was admitted to a hospital because of their asthma . Only 28 % had ever self-monitored asthma before entering the study . However , none of the patients referred unwillingness to monitor their asthma in the future , and 56 % of them were strongly in favor to its use ; furthermore , one-third of patients were happy to monitor their symptoms daily , whereas another third preferred to do it less than once a week . Also , one in five considered it was easy to forget to register symptoms in the paper diary , and all patients considered it to help them better underst and their disease . The proportions of referred willingness to use mobile  or web technologies  to support self-management are described in Table 1 . There were no significant associations between willingness to use mobile or web technologies and patient ’s sex , age , education level , socio-economic status , tobacco usage , other chronic diseases , and duration and severity of asthma . Caution is needed in the generalization of these results as the patients who were studied were mostly middle-aged women with low education , and low socio-economic background , who had moderate to severe asthma followed at secondary care . Nevertheless , a large majority of patients seem willing and ready to use communication technologies such as mobile phones and the Web to help them manage their asthma . Are the doctors and the health administrators also ready to test the effectiveness of this AL LERGY 2 0 0 6 : 6 1 : 3 8 9 – 3 9 5 • COPYR IGHT a 2006 BLACKWELL MUNKSGAARD • ALL R IGHTS RESERVED • CONTRIBUT IONS TO THIS SECT ION WILL NOT UNDERGO PEER REVIEW , BUT WILL BE REV IEWED BY THE ASSOCIATE EDITORS In this prospect i ve , multicenter , r and omized , controlled , double‐blind study , we investigated the impact of a mobile patient engagement application on health outcomes and quality of life in allergic rhinitis ( AR ) and asthma patients Importance Although asthma is a chronic disease , the expected rate of spontaneous remissions of adult asthma and the stability of diagnosis are unknown . Objective To determine whether a diagnosis of current asthma could be ruled out and asthma medications safely stopped in r and omly selected adults with physician-diagnosed asthma . Design , Setting , and Participants A prospect i ve , multicenter cohort study was conducted in 10 Canadian cities from January 2012 to February 2016 . R and om digit dialing was used to recruit adult participants who reported a history of physician-diagnosed asthma established within the past 5 years . Participants using long-term oral steroids and participants unable to be tested using spirometry were excluded . Information from the diagnosing physician was obtained to determine how the diagnosis of asthma was originally made in the community . Of 1026 potential participants who fulfilled eligibility criteria during telephone screening , 701 ( 68.3 % ) agreed to enter into the study . All participants were assessed with  home peak flow and symptom monitoring , spirometry , and serial bronchial challenge tests  , and those participants using daily asthma medications had their medications gradually tapered off over 4 study visits . Participants in whom a diagnosis of current asthma was ultimately ruled out were followed up clinical ly with repeated bronchial challenge tests over 1 year . Exposure Physician-diagnosed asthma established within the past 5 years . Main Outcomes and Measures The primary outcome was the proportion of participants in whom a diagnosis of current asthma was ruled out , defined as participants who exhibited no evidence of acute worsening of asthma symptoms , reversible airflow obstruction , or bronchial hyperresponsiveness after having all asthma medications tapered off and after a study pulmonologist established an alternative diagnosis . Secondary outcomes included the proportion with asthma ruled out after 12 months and the proportion who underwent an appropriate initial diagnostic workup for asthma in the community . Results Of 701 participants ( mean [ SD ] age , 51 [ 16 ] years ; 467 women [ 67 % ] ) , 613 completed the study and could be conclusively evaluated for a diagnosis of current asthma . Current asthma was ruled out in 203 of 613 study participants ( 33.1 % ; 95 % CI , 29.4%-36.8 % ) . Twelve participants ( 2.0 % ) were found to have serious cardiorespiratory conditions that had been previously misdiagnosed as asthma in the community . After an additional 12 months of follow-up , 181 participants ( 29.5 % ; 95 % CI , 25.9%-33.1 % ) continued to exhibit no clinical or laboratory evidence of asthma . Participants in whom current asthma was ruled out , compared with those in whom it was confirmed , were less likely to have undergone testing for airflow limitation in the community at the time of initial diagnosis ( 43.8 % vs 55.6 % , respectively ; absolute difference , 11.8 % ; 95 % CI , 2.1%-21.5 % ) . Conclusions and Relevance Among adults with physician-diagnosed asthma , a current diagnosis of asthma could not be established in 33.1 % who were not using daily asthma medications or had medications weaned . In patients such as these , reassessing the asthma diagnosis may be warranted Context Patient self-management is an essential component of asthma care , and the Internet is a medium to potentially support patients in self-management . Contribution This r and omized trial compared Internet-based asthma self-management with usual care and found modest improvements in asthma control and lung function with the Internet intervention , but found no reduction in exacerbations and changes in asthma-related quality of life that were less than clinical ly significant at 12 months . Implication Although Internet-based self management can improve some asthma outcomes , the improvements were small and the program did not reduce the number of exacerbations . The Editors Asthma is a chronic disorder of the airways that is characterized by recurring respiratory symptoms , variable airflow obstruction , airway hyperresponsiveness , and underlying inflammation ( 1 , 2 ) . Recent clinical guidelines for the management of asthma distinguish 4 essential components of asthma care : assessment and monitoring , patient education , control of environmental and comorbid factors that affect asthma , and drug treatment . With appropriate medical care , well-informed and empowered patients can control their asthma and live full , active lives ( 1 , 2 ) . However , despite the availability of monitoring tools and effective therapy , asthma control is suboptimal in many patients worldwide , and long-term management falls far short of the goals set in the guidelines ( 3 ) . Self-monitoring , education , and specific medical care are important aspects in improving the lives of patients with asthma ( 1 , 2 ) . However , many patients with mild or moderate persistent asthma do not attend checkups regularly or visit their physician with symptoms of the disease ( 4 ) . In addition , in practice , both patients and their health care providers are reluctant to use written self-management plans ( 5 ) . Internet technology is increasingly seen as an appealing tool to support self-management for patients with chronic disease in remote and underserved population s ( 68 ) . However , to date , studies on Internet-based asthma self-management show only short-term improvements in asthma control , lung function , and quality of life ( 911 ) . Long-term studies on the effect of Internet-based self-management , including all its essential features , are not available . Therefore , we developed a guided self-management tool for adult patients with asthma that included Internet-based home monitoring and treatment advice ( action plan ) , online education , and remote Web communication with a specialized asthma nurse . The goal of our study was to assess the long-term clinical effectiveness of  Internet-based self-management education  compared with usual physician-provided care alone . Methods Design Overview We conducted a 12-month , multicenter , nonblinded , r and omized , controlled trial . We r and omly assigned patients to Internet-based self-management ( Internet group ) as an adjunct to usual care or to usual physician-provided care alone ( usual care group ) . The Internet-based self-management program included weekly asthma control monitoring and treatment advice , online and group education , and remote Web communications with a specialized asthma nurse . The intervention continued for 12 months after enrollment . The Medical Ethics Committee of the Leiden University Medical Center , Leiden , the Netherl and s , approved the study . Setting and Participants We recruited patients from 37 general practice s ( 69 general practitioners ) in the Leiden and The Hague area and the Outpatient Clinic of the Department of Pulmonology at the Leiden University Medical Center from September 2005 to September 2006 . Inclusion criteria were physician-diagnosed asthma coded according to the International Classification of Primary Care in the electronic medical record ( 12 ) , age 18 to 50 years , prescription of inhaled corticosteroids for at least 3 months in the previous year , no serious comorbid conditions that interfered with asthma treatment , access to the Internet at home , and mastery of the Dutch language . We excluded patients who were receiving maintenance oral glucocorticosteroid treatment .  On the basis of diagnosis , age , prescribed asthma medication , and comorbid conditions , we sent eligible patients an invitation letter followed by 1 reminder letter after 2 to 4 weeks if they did not respond to the first . We continued this process until a total of 200 patients had entered the study ( September 2006 ) . All participants gave written consent . R and omization and Intervention In a 2-week baseline period before r and omization , we collected data on patient demographic characteristics , asthma-related quality of life , symptom control , lung function , and medication level . We provided basic education about core information on asthma , action of medications , and inhaler technique instructions to all patients . We trained all participants to measure FEV1 daily with a h and -held electronic spirometer ( PiKo-1 , Ferraris Respiratory , Hertford , United Kingdom ) and to report the highest value of 3 measurements in the morning before taking medication ( 2 , 13 ) . They were shown how to report these values on a personal page on a secure Web application by using a login password ( or how to report by mobile telephone text message ) . Patients were also asked to report their nighttime and daytime asthma symptom scores on this Internet page or by text message . We asked all participants to complete the Asthma Control Question naire on their personal Internet page each week ( 14 ) . We did not give any patients feedback about lung function or asthma control . After the 2-week baseline period , we r and omly assigned participants to either the Internet group or the usual care group . We stratified according to care provider ( primary vs. subspecialty care ) and asthma control at baseline ( 15 ) . We r and omly assigned patients to the 2 groups ( 1:1 ratio ) by using a computer-generated , permuted-block scheme . Allocation took place by computer after collection of the baseline data , ensuring concealment of allocation . The Internet-based self-management program consisted of the 4 principal components of asthma self-management and was accessed through the specially design ed Web site , which allowed monitoring through the Web site ( or text message on a mobile telephone ) , use of an Internet-based treatment plan , online education , and Web communications with a specialized asthma nurse ( 16 ) . Patients monitored their asthma weekly by completing an electronic version of the Asthma Control Question naire on the Web site and instantly received feedback on the current state of their asthma control along with advice on how to adjust their treatment according to a predefined algorithm and treatment plan ( Table 1 and Appendix Figures 1 , 2 , 3 , 4 , and 5 ) . Depending on the scores su bmi tted , patients received 4 types of self-treatment advice . When 4 consecutive Asthma Control Question naire scores were 0.5 or less , patients were advised to decrease treatment according to treatment plan . When 2 consecutive scores were greater than 0.5 but less than 1.0 , patients were advised to increase treatment according to treatment plan . When 1 score was 1.0 or more but less than 1.5 , patients were advised to immediately increase treatment according to treatment plan . Finally , when 1 score was 1.5 or more , patients were advised to immediately increase treatment and contact the asthma nurse . Table 1 . Treatment Plan Appendix Figure 1 . Algorithm based on consecutive ACQ scores to adjust medical treatment . * ACQ = Asthma Control Question naire . At entry of the algorithm , the evaluation period is bypassed . The evaluation period starts after treatment was stepped up . The optimal control period starts after 1 ACQ score 0.5 and ends after 1 ACQ score > 0.5 . Appendix Figure 2 . Screen shot of daily lung function and symptom monitoring . Appendix Figure 3 . Screen shot of feedback on daily lung function and symptom monitoring . Appendix Figure 4 . Screen shot of weekly Asthma Control Question naire monitoring . Appendix Figure 5 . Screen shot of feedback on Asthma Control Question naire , treatment advice according to personalized treatment plan , and results of past 6 months . We advised no medication changes during the 4 weeks after treatment was stepped up ( evaluation period ) . In addition to weekly assessment s , patients could optionally report daily symptoms and lung function and were able to contact our asthma nurse though the Web or by telephone . Thus , any acute deterioration warranting a visit to the general practitioner or hospital could be detected ( Appendix Figures 2 and 3 ) . We aim ed to empower patients to use the Internet-based self-management tool and to develop a patientprovider partnership in asthma care ( 2 ) . Self-management education consisted of both Web-based and face-to-face , group-based education . Web-based education included asthma information , news , frequently asked questions , and interactive communication with a respiratory nurse specialist . We scheduled 2 group-based education sessions , which lasted 45 to 60 minutes , for patients in the  Internet-based self-management group  within 6 weeks after entering the trial . Both sessions included exploration of a patient 's interests and previous knowledge ( negotiating an agenda and patient-centered education ) , personalized feedback , and empowerment of self-management ( self-efficacy and implementing a plan for change ) ( 2 , 17 ) . The first educational session also included pathophysiology of asthma , information on the  Web-based action plan  , and information and review of inhalation technique .  The second educational session gave information about the mechanisms and side effects of medication and explained trigger avoidance . Patients in the usual care group received asthma care according to the Dutch general practice guidelines on asthma management in adults , which recommend a medical review and treatment adjustment every 2 to 4 weeks in unstable asthma and medical review once or twice BACKGROUND Poor adherence to asthma treatment is a well-recognised challenge and is associated with increased morbidity , mortality and consumption of health care re sources . This study examined the impact of receiving a daily text message reminder on one 's cell phone on adherence to asthma treatment . METHODS A total of 26 subjects aged 18 - 45 years , with a clinical history of asthma and a positive methacholine challenge test ( PD(20)<or=4micromol ) were r and omised to receive , or to not receive , a daily short message service ( SMS ) reminder on their cell phone to take their anti-asthmatic medication . Inhaled corticosteroids to last for eight weeks and a prescription for four additional weeks were given to the subjects . The primary outcome was adherence to asthma treatment . Secondary outcomes were reimbursement of asthma medication , and change in exhaled nitric oxide levels , lung function , and airway responsiveness . RESULTS The absolute difference in mean adherence rate between the two groups after 12 weeks was 17.8 % , 95 % CI ( 3.2 - 32.3 % ) , p=0.019 . No significant differences were observed between the two r and omisation groups for the secondary outcomes . CONCLUSION Daily text message reminders are already after a short period of observation associated with increased adherence to anti-asthmatic medication BACKGROUND AND OBJECTIVE Poorly controlled asthma during pregnancy is hazardous for both mother and foetus . Better asthma control may be achieved if patients are involved in regular self-monitoring of symptoms and self-management according to a written asthma action plan . Telehealth applications to optimize asthma management and outcomes in pregnant women have not yet been evaluated . This study evaluated the efficacy of a telehealth programme supported by a h and held respiratory device in improving asthma control during pregnancy . METHODS Pregnant women with asthma ( n = 72 ) from two antenatal clinics in Melbourne , Australia , were r and omized to one of two groups : ( i ) intervention-involving a telehealth programme ( management of asthma with supportive telehealth of respiratory function in pregnancy ( MASTERY ( © ) ) ) supported by a h and held respiratory device and an And roid smart phone application ( Breathe-easy ( © ) ) and written asthma action plan or ( ii ) control-usual care . The primary outcome was change in asthma control at 3 and 6 months ( prenatal ) . Secondary outcomes included changes in quality of life and lung function , and perinatal/neonatal outcomes . RESULTS At baseline , participants ' mean ( ± st and ard deviation ) age was 31.4 ± 4.5 years and gestational age 16.7 ± 3.1 weeks . At 6 months , the MASTERY group had better asthma control ( P = 0.02 ) and asthma-related quality of life ( P = 0.002 ) compared with usual care . There were no significant differences between groups in lung function , unscheduled health-care visits , days off work/ study , oral corticosteroid use , or perinatal outcomes . Differences between groups were not significant at 3 months . CONCLUSION Telehealth interventions supporting self-management are feasible and could potentially improve asthma control and asthma-related quality of life during pregnancy
BACKGROUND Mobile technology interventions ( MTI ) are becoming increasingly popular in the management of chronic health behaviors .
Most MTI allow individuals to monitor medication use , record symptoms , or store and activate disease-management action plans .
Therefore , MTI may have the potential to improve low adherence to medication and action plans for individuals with asthma , which is associated with poor clinical outcomes .
OBJECTIVE A systematic review and meta- analysis were conducted to evaluate the efficacy of MTI on clinical outcomes as well as adherence in individuals with asthma .
As the use of evidence -based behavior change techniques ( BCT ) has been shown to improve intervention effects , we also conducted exploratory analyses to determine the role of BCT and engagement with MTI as moderators of MTI efficacy .