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of life, symptom-free days, asthma control and lung function as compared to usual care. More recently, a post-hoc analysis of the study demonstrated that patients with partly controlled or uncontrolled asthma benefited the most from the telemanagement strategy [25]. In addition, this study showed that about 60% of the patients were still using the telemanagement service on their individual indication, after one year. There was a wide variability in the intensity of the usage of the telemanagement service, based on patient preferences, which was the most intensive during the first three months. This illustrates that telemanagement does not seems to make patients too dependent on technological support but rather supports informed and educated patient autonomy.
In addition, the benefits shown in patients with mild to moderate asthma, telemanagement might be particularly advantageous for children and adults with severe persistent asthma who are at higher risk of hospital admission due to asthma exacerbations or patients who have prednisone-dependent asthma [26;27]. In a study performed in Taiwan [28] it was demonstrated that patients with severe asthma who were managed via a mobile telephone based interactive system had a significant improvement in lung function and reduced number of exacerbations as compared with patients included in the usual care strategy (paper self-management tools only). The patients in the mobile phone group received a software package for their mobile phone, which consisted of an electronic diary (peak expiratory flow rate, daily asthma symptom score, need for reliever use) and a treatment decision support tool which gave feedback based on the level of asthma control from the previous seven days.
Another study focused on tapering of oral corticosteroid dose in patients with prednisone-dependent asthma [29]. In this randomized controlled trial a strategy combining an internet-based tool and daily monitoring of symptoms, lung function and Fraction of exhaled nitric oxide (FeNO) was superior to usual care in tapering the dose of oral corticosteroid in patients with prednisone dependent asthma, without decreasing lung function or asthma related quality of life. Patients in the internet-group had access to a web-page consisting of an electronic diary (lung function, FENO, daily asthma symptom score and assessment of asthma control), on which patients received direct treatment advice. Compliance with the monitoring measurements and entering the data
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