title: Home telemonitoring (forced expiratory volume in 1 s) in children with severe asthma does not reduce exacerbations.
abstract: Some children with severe asthma develop frequent exacerbations despite intensive treatment. We sought to assess the outcome (severe exacerbations and healthcare use, lung function, quality of life and maintenance treatment) of a strategy based on daily home spirometry with teletransmission to an expert medical centre and whether it differs from that of a conventional strategy. 50 children with severe uncontrolled asthma were enrolled in a 12-month prospective study and were randomised into two groups: 1) treatment managed with daily home spirometry and medical feedback (HM) and 2) conventional treatment (CT). The children's mean age was 10.9 yrs (95% confidence interval 10.2-11.6). 44 children completed the study (21 in the HM group and 23 in the CT group). The median number of severe exacerbations per patient was 2.0 (interquartile range 1.0-4.0) in the HM group and 3.0 (1.0-4.0) in the CT group (p=0.38 with adjustment for age). There were no significant differences between the two groups for unscheduled visits (HM 5.0 (3.0-7.0), CT 3.0 (2.0-7.0); p=0.30), lung function (pre-β(2)-agonist forced expiratory volume in 1 s (FEV(1)) p=0.13), Paediatric Asthma Quality of Life Questionnaire scores (p=0.61) and median daily dose of inhaled corticosteroids (p=0.86). A treatment strategy based on daily FEV(1) monitoring with medical feedback did not reduce severe asthma exacerbations.
authors.affiliation: Unité de Pneumologie-Allergologie Pédiatrique, Clinique de Pédiatrie Jeanne de Flandre, CHRU, 59037 Lille cedex, France. antoine.deschildre@chru-lille.fr
authors.forename: A
authors.initials: A
authors.lastname: Deschildre
authors.forename: L
authors.initials: L
authors.lastname: Béghin
authors.forename: J
authors.initials: J
authors.lastname: Salleron
authors.forename: C
authors.initials: C
authors.lastname: Iliescu
authors.forename: C
authors.initials: C
authors.lastname: Thumerelle
authors.forename: C
authors.initials: C
authors.lastname: Santos
authors.forename: A
authors.initials: A
authors.lastname: Hoorelbeke
authors.forename: M
authors.initials: M
authors.lastname: Scalbert
authors.forename: G
authors.initials: G
authors.lastname: Pouessel
authors.forename: M
authors.initials: M
authors.lastname: Gnansounou
authors.forename: J-L
authors.initials: JL
authors.lastname: Edmé
authors.forename: R
authors.initials: R
authors.lastname: Matran
mesh_terms: D000293:Adolescent; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D010290:Parents / Q000523:psychology; D011446:Prospective Studies; D011788:Quality of Life; D012720:Severity of Illness Index; D013147:Spirometry / Q000379:methods*; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000379:methods*; D017211:Treatment Failure
chemical_list: D018927:Anti-Asthmatic Agents