title: Monitoring strategies in children with asthma: a randomised controlled trial.
abstract: BACKGROUND
  Asthma guidelines recommend monitoring of asthma control. However, in a substantial proportion of children, asthma is poorly controlled and the best monitoring strategy is not known.
  
  
  OBJECTIVE
  We studied two monitoring strategies for their ability to improve asthma outcomes in comparison with standard care (SC): web-based monthly monitoring with the (Childhood) Asthma Control Test (ACT or C-ACT) and 4-monthly monitoring of FENO.
  
  
  METHODS
  In this randomised controlled, partly blinded, parallel group multicentre trial with a 1-year follow-up, children aged 4-18 with a doctor's diagnosis of asthma treated in seven hospitals were randomised to one of the three groups. In the web group, treatment was adapted according to ACT obtained via a website at 1-month intervals; in the FENO group according to ACT and FENO, and in the SC group according to the ACT at 4-monthly visits. The primary endpoint was the change from baseline in the proportion of symptom-free days (SFD).
  
  
  RESULTS
  Two-hundred and eighty children (mean age 10.4 years, 66% boys) were included; 268 completed the study. Mean changes from baseline in SFD were similar between the groups: -2.1% (web group, n=90), +8.9% (FENO group, n=91) versus 0.15% (SC, n=87), p=0.15 and p=0.78. Daily dose of inhaled corticosteroids (ICS) decreased more in the web-based group compared with both other groups (-200 μg/day, p<0.01), while ACT and SFD remained similar.
  
  
  CONCLUSIONS
  The change from baseline in SFD did not differ between monitoring strategies. With web-based ACT monitoring, ICS could be reduced substantially while control was maintained.
  
  
  BACKGROUND
  NTR 1995.
authors.affiliation: Department of Paediatrics, Division Paediatric Respiratory Medicine, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, the Netherlands.
authors.forename: Sandra
authors.initials: S
authors.lastname: Voorend-van Bergen
authors.affiliation: Department of Paediatrics, Amphia Hospital, Breda, the Netherlands.
authors.forename: Anja A
authors.initials: AA
authors.lastname: Vaessen-Verberne
authors.affiliation: Department of Paediatrics, Catharina Hospital, Eindhoven, the Netherlands.
authors.forename: Hein J
authors.initials: HJ
authors.lastname: Brackel
authors.affiliation: Department of Paediatrics, Rijnstate Hospital, Arnhem, the Netherlands.
authors.forename: Anneke M
authors.initials: AM
authors.lastname: Landstra
authors.affiliation: Department of Paediatrics, Flevo Hospital-De Kinderkliniek, Almere, the Netherlands.
authors.forename: Norbert J
authors.initials: NJ
authors.lastname: van den Berg
authors.affiliation: Department of Biostatistics, Erasmus University Medical Centre, Rotterdam, the Netherlands.
authors.forename: Wim C
authors.initials: WC
authors.lastname: Hop
authors.affiliation: Department of Paediatrics, Division Paediatric Respiratory Medicine, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, the Netherlands.
authors.forename: Johan C
authors.initials: JC
authors.lastname: de Jongste
authors.affiliation: Department of Paediatric Pulmonology, Radboud University Medical Centre, Nijmegen, the Netherlands.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Merkus
authors.affiliation: Department of Paediatrics, Division Paediatric Respiratory Medicine, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, the Netherlands.
authors.forename: Mariëlle W
authors.initials: MW
authors.lastname: Pijnenburg
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D001249:Asthma / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019819:Budesonide / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods*; D009426:Netherlands; D011446:Prospective Studies; D011788:Quality of Life; D012129:Respiratory Function Tests / Q000379:methods; D016037:Single-Blind Method; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D001993:Bronchodilator Agents; D005938:Glucocorticoids; D019819:Budesonide
keywords: Paediatric asthma