Cargando…
Weekly self-monitoring and treatment adjustment benefit patients with partly controlled and uncontrolled asthma: an analysis of the SMASHING study
BACKGROUND: Internet-based self-management has shown to improve asthma control and asthma related quality of life, but the improvements were only marginally clinically relevant for the group as a whole. We hypothesized that self-management guided by weekly monitoring of asthma control tailors pharma...
Autores principales: | , , , , , , , |
---|---|
Formato: | Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2010
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2893513/ https://www.ncbi.nlm.nih.gov/pubmed/20537124 http://dx.doi.org/10.1186/1465-9921-11-74 |
_version_ | 1782183045877465088 |
---|---|
author | van der Meer, Victor van Stel, Henk F Bakker, Moira J Roldaan, Albert C Assendelft, Willem JJ Sterk, Peter J Rabe, Klaus F Sont, Jacob K |
author_facet | van der Meer, Victor van Stel, Henk F Bakker, Moira J Roldaan, Albert C Assendelft, Willem JJ Sterk, Peter J Rabe, Klaus F Sont, Jacob K |
author_sort | van der Meer, Victor |
collection | PubMed |
description | BACKGROUND: Internet-based self-management has shown to improve asthma control and asthma related quality of life, but the improvements were only marginally clinically relevant for the group as a whole. We hypothesized that self-management guided by weekly monitoring of asthma control tailors pharmacological therapy to individual needs and improves asthma control for patients with partly controlled or uncontrolled asthma. METHODS: In a 1-year randomised controlled trial involving 200 adults (18-50 years) with mild to moderate persistent asthma we evaluated the adherence with weekly monitoring and effect on asthma control and pharmacological treatment of a self-management algorithm based on the Asthma Control Questionnaire (ACQ). Participants were assigned either to the Internet group (n = 101) that monitored asthma control weekly with the ACQ on the Internet and adjusted treatment using a self-management algorithm supervised by an asthma nurse specialist or to the usual care group (UC) (n = 99). We analysed 3 subgroups: patients with well controlled (ACQ ≤ 0.75), partly controlled (0.75>ACQ ≤ 1.5) or uncontrolled (ACQ>1.5) asthma at baseline. RESULTS: Overall monitoring adherence was 67% (95% CI, 60% to 74%). Improvements in ACQ score after 12 months were -0.14 (p = 0.23), -0.52 (p < 0.001) and -0.82 (p < 0.001) in the Internet group compared to usual care for patients with well, partly and uncontrolled asthma at baseline, respectively. Daily inhaled corticosteroid dose significantly increased in the Internet group compared to usual care in the first 3 months in patients with uncontrolled asthma (+278 μg, p = 0.001), but not in patients with well or partly controlled asthma. After one year there were no differences in daily inhaled corticosteroid use or long-acting β(2)-agonists between the Internet group and usual care. CONCLUSIONS: Weekly self-monitoring and subsequent treatment adjustment leads to improved asthma control in patients with partly and uncontrolled asthma at baseline and tailors asthma medication to individual patients' needs. TRIAL REGISTRATION: Current Controlled Trials ISRCTN79864465 |
format | Text |
id | pubmed-2893513 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2010 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-28935132010-06-30 Weekly self-monitoring and treatment adjustment benefit patients with partly controlled and uncontrolled asthma: an analysis of the SMASHING study van der Meer, Victor van Stel, Henk F Bakker, Moira J Roldaan, Albert C Assendelft, Willem JJ Sterk, Peter J Rabe, Klaus F Sont, Jacob K Respir Res Research BACKGROUND: Internet-based self-management has shown to improve asthma control and asthma related quality of life, but the improvements were only marginally clinically relevant for the group as a whole. We hypothesized that self-management guided by weekly monitoring of asthma control tailors pharmacological therapy to individual needs and improves asthma control for patients with partly controlled or uncontrolled asthma. METHODS: In a 1-year randomised controlled trial involving 200 adults (18-50 years) with mild to moderate persistent asthma we evaluated the adherence with weekly monitoring and effect on asthma control and pharmacological treatment of a self-management algorithm based on the Asthma Control Questionnaire (ACQ). Participants were assigned either to the Internet group (n = 101) that monitored asthma control weekly with the ACQ on the Internet and adjusted treatment using a self-management algorithm supervised by an asthma nurse specialist or to the usual care group (UC) (n = 99). We analysed 3 subgroups: patients with well controlled (ACQ ≤ 0.75), partly controlled (0.75>ACQ ≤ 1.5) or uncontrolled (ACQ>1.5) asthma at baseline. RESULTS: Overall monitoring adherence was 67% (95% CI, 60% to 74%). Improvements in ACQ score after 12 months were -0.14 (p = 0.23), -0.52 (p < 0.001) and -0.82 (p < 0.001) in the Internet group compared to usual care for patients with well, partly and uncontrolled asthma at baseline, respectively. Daily inhaled corticosteroid dose significantly increased in the Internet group compared to usual care in the first 3 months in patients with uncontrolled asthma (+278 μg, p = 0.001), but not in patients with well or partly controlled asthma. After one year there were no differences in daily inhaled corticosteroid use or long-acting β(2)-agonists between the Internet group and usual care. CONCLUSIONS: Weekly self-monitoring and subsequent treatment adjustment leads to improved asthma control in patients with partly and uncontrolled asthma at baseline and tailors asthma medication to individual patients' needs. TRIAL REGISTRATION: Current Controlled Trials ISRCTN79864465 BioMed Central 2010 2010-06-10 /pmc/articles/PMC2893513/ /pubmed/20537124 http://dx.doi.org/10.1186/1465-9921-11-74 Text en Copyright ©2010 van der Meer et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research van der Meer, Victor van Stel, Henk F Bakker, Moira J Roldaan, Albert C Assendelft, Willem JJ Sterk, Peter J Rabe, Klaus F Sont, Jacob K Weekly self-monitoring and treatment adjustment benefit patients with partly controlled and uncontrolled asthma: an analysis of the SMASHING study |
title | Weekly self-monitoring and treatment adjustment benefit patients with partly controlled and uncontrolled asthma: an analysis of the SMASHING study |
title_full | Weekly self-monitoring and treatment adjustment benefit patients with partly controlled and uncontrolled asthma: an analysis of the SMASHING study |
title_fullStr | Weekly self-monitoring and treatment adjustment benefit patients with partly controlled and uncontrolled asthma: an analysis of the SMASHING study |
title_full_unstemmed | Weekly self-monitoring and treatment adjustment benefit patients with partly controlled and uncontrolled asthma: an analysis of the SMASHING study |
title_short | Weekly self-monitoring and treatment adjustment benefit patients with partly controlled and uncontrolled asthma: an analysis of the SMASHING study |
title_sort | weekly self-monitoring and treatment adjustment benefit patients with partly controlled and uncontrolled asthma: an analysis of the smashing study |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2893513/ https://www.ncbi.nlm.nih.gov/pubmed/20537124 http://dx.doi.org/10.1186/1465-9921-11-74 |
work_keys_str_mv | AT vandermeervictor weeklyselfmonitoringandtreatmentadjustmentbenefitpatientswithpartlycontrolledanduncontrolledasthmaananalysisofthesmashingstudy AT vanstelhenkf weeklyselfmonitoringandtreatmentadjustmentbenefitpatientswithpartlycontrolledanduncontrolledasthmaananalysisofthesmashingstudy AT bakkermoiraj weeklyselfmonitoringandtreatmentadjustmentbenefitpatientswithpartlycontrolledanduncontrolledasthmaananalysisofthesmashingstudy AT roldaanalbertc weeklyselfmonitoringandtreatmentadjustmentbenefitpatientswithpartlycontrolledanduncontrolledasthmaananalysisofthesmashingstudy AT assendelftwillemjj weeklyselfmonitoringandtreatmentadjustmentbenefitpatientswithpartlycontrolledanduncontrolledasthmaananalysisofthesmashingstudy AT sterkpeterj weeklyselfmonitoringandtreatmentadjustmentbenefitpatientswithpartlycontrolledanduncontrolledasthmaananalysisofthesmashingstudy AT rabeklausf weeklyselfmonitoringandtreatmentadjustmentbenefitpatientswithpartlycontrolledanduncontrolledasthmaananalysisofthesmashingstudy AT sontjacobk weeklyselfmonitoringandtreatmentadjustmentbenefitpatientswithpartlycontrolledanduncontrolledasthmaananalysisofthesmashingstudy |