title: Clinical efficacy of web-based versus standard asthma self-management.
abstract: BACKGROUND
  Guided self-management is an important component of asthma care. Most trials have evaluated paper-based strategies. The effectiveness of new communication technologies remains uncertain.
  
  
  OBJECTIVE
  To compare the feasibility and clinical outcomes of a standard paper-based asthma self-management strategy with web-based strategies.
  
  
  METHODS
  In a crossover trial, 21 patients using inhaled corticosteroids and long-acting B2-agonists (mean [SD] age 29 [10] years) were randomly assigned to use a sequence of web-based and paper-based diary and action plan. Quality of life, asthma control, lung function, and airway inflammation were assessed using the Asthma Life Quality Questionnaire (ALQ), Asthma Control Questionnaire (ACQ-5), Mini Asthma Quality of Life Questionnaire (Mini AQLQ), and office spirometry. The ratio of forced expiratory volume in the first second of expiration (FEV1) to peak expiratory flow (PEF) rate (PiKo-1) and fraction of exhaled nitric oxide (FE(NO)) were monitored. The main clinical outcomes were asthma control and FE(NO). Quality of data and adherence to monitoring tools were the main process outcomes.
  
  
  RESULTS
  Significant improvements were observed in the AQL and ACQ scores, although lung function did not change. FE(NO) was significantly reduced only after a web-based strategy but a significant period effect occurred (P = .006). There were no differences in clinical outcomes between web-based and paper-based management. No intervention-related adverse effects were observed. Adherence seemed higher with the paper-based strategy (P < .001). However, paper data were unreliable when compared to automatic daily electronic FEV1/PEF records. Twelve patients were very interested in continuing self-management with the web-based approach compared with 2 in using paper tools (P = .002).
  
  
  CONCLUSIONS
  Web-based management was feasible, safe, and preferred by patients. Short-term outcomes were at least as good, and data quality was improved.
authors.affiliation: Serviço de Imunologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
authors.forename: L
authors.initials: L
authors.lastname: Araújo
authors.forename: T
authors.initials: T
authors.lastname: Jacinto
authors.forename: A
authors.initials: A
authors.lastname: Moreira
authors.forename: M G
authors.initials: MG
authors.lastname: Castel-Branco
authors.forename: L
authors.initials: L
authors.lastname: Delgado
authors.forename: A
authors.initials: A
authors.lastname: Costa-Pereira
authors.forename: J
authors.initials: J
authors.lastname: Fonseca
mesh_terms: D000328:Adult; D001249:Asthma / Q000503:physiopathology / Q000628:therapy*; D018592:Cross-Over Studies; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D020407:Internet; D008297:Male; D008499:Medical Records; D009569:Nitric Oxide / Q000032:analysis; D010349:Patient Compliance; D010366:Peak Expiratory Flow Rate; D011788:Quality of Life; D012129:Respiratory Function Tests; D012648:Self Care / Q000379:methods*; D011795:Surveys and Questionnaires; D017216:Telemedicine; D016896:Treatment Outcome
chemical_list: D009569:Nitric Oxide