title: Long-term outcomes of internet-based self-management support in adults with asthma: randomized controlled trial.
abstract: 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 randomized 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 practices 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 Questionnaire (ACQ) and the Asthma Quality of Life Questionnaire (AQLQ) were completed by 107 participants (60 UC participants and 47 IG participants). A minimal clinical important difference in both questionnaires 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.
  
  
  BACKGROUND
  International Standard Randomized Controlled Trial Number (ISRCTN): 79864465; http://www.controlled-trials.com/ISRCTN79864465 (Archived by WebCite at http://www.webcitation.org/6J4VHhPk4).
authors.affiliation: Leiden University Medical Center, Department of Medical Decision Making, Leiden, Netherlands.
authors.forename: Johanna L
authors.initials: JL
authors.lastname: van Gaalen
authors.forename: Thijs
authors.initials: T
authors.lastname: Beerthuizen
authors.forename: Victor
authors.initials: V
authors.lastname: van der Meer
authors.forename: Patricia
authors.initials: P
authors.lastname: van Reisen
authors.forename: Geertje W
authors.initials: GW
authors.lastname: Redelijkheid
authors.forename: Jiska B
authors.initials: JB
authors.lastname: Snoeck-Stroband
authors.forename: Jacob K
authors.initials: JK
authors.lastname: Sont
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage; D000328:Adult; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012648:Self Care / Q000379:methods*; D011795:Surveys and Questionnaires; D017216:Telemedicine; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists
keywords: Internet; asthma; eHealth; long-term; quality of life; self-management; telemedicine
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