Limitations
atopic, asthma, expiratory airflow
ASTHMATIC, ATOPIC, ASTHMA
The first limitation of our study was that it was not certain whether all participants were asthmatic, as the evidence of variable expiratory airflow limitation was not an inclusion criterion. Nevertheless, inclusion and noninclusion criteria allowed being confident with the inclusion of participants who were truly asthmatic, mainly those who were atopic; moreover, the severe exacerbation rate observed was in accordance with previous studies. The second limitation of our trial was the provision of the WAP to all patients. Not providing a WAP would have been incompatible with the current guidelines, and we could not be sure that an internet connection would always be available. Third, WAP use was self-reported every 3 months and may, therefore, have been subject to recall bias. As for the DAP, the number of connections recorded in the app was consistent with the number reported during the telephone interviews. Fourth, all patients received the same WAP, which complied with French recommendations, but developing WAPs in discussion with each patient might improve effectiveness. However, our study assessed whether adding a DAP was beneficial, and the characteristics of the WAP could not have affected our findings. Fifth, neither the education session delivered at the time the WAP was provided nor the follow-up by physicians was standardized, which could have modified the asthma education received by patients and families. Sixth, the numbers of children and adults were not sufficient for performing separate statistical analyses in the 2 age groups; such analyses were planned initially [