Page 108 - Comprehensive treatment of patients with glucocorticoid-dependent severe asthma

Chapter 6
into the website was very high and patients were overall satisfied with the telemanagement strategy.
Two recent studies investigated aspects of telemanagement in the care of children with asthma. Deschildre et al. compared a telemonitoring strategy consisting of home spirometry and medical feedback by a professional with a conventional treatment strategy (usual care and a paper diary for symptom, rescue treatment and healthcare use registration) in children with severe uncontrolled asthma [30]. The authors were unable to find a difference in severe exacerbations (primary outcome), health care usage, inhaled corticosteroids maintenance treatment, lung function, and quality of life. However, this relatively small study might have been underpowered, since they required 26 patients per group to detect a difference between groups on the primary outcome but the end-point analysis could be determined in only 44 patients after 3 months of study, and in only 35 patients after 1 year, respectively. In another recent study, Van der Valk et al. [31;32] conducted a post hoc analysis on daily FeNO measurements in 77 children with allergic asthma. The authors concluded that daily telemonitoring of FeNO can detect changes prior to a moderate asthma exacerbation. Whether this information is a valuable basis for subsequent treatment adjustments and whether that might result in a reduction of the exacerbation rate and the number of hospital admissions needs further study. Therefore, the practical implications of daily telemonitoring of FeNO in these patients are not yet clear.
Summarizing, the most recent available studies in children and adults show that telemanagement applications, whether involving mobile telephone- based interactive systems or internet-based systems, are promising tools for supporting the management of patients with asthma. There is increasing evidence that a comprehensive telemanagement approach leads to an important gain in quality of life and clinical outcomes, especially in adult patients with moderate to severe asthma and supports informed and educated patient autonomy [28;29]. The application of telemanagement in the care of children with asthma was feasible and well accepted by patients [30]. However, well-designed and sufficiently powered studies are required to evaluate the long-term effects of telemanagement in children with asthma.
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