Patients with severe asthma require continuous medical supervision, which can often be a logistical challenge, not only for overburdened healthcare systems, but for patients themselves. "Internet monitoring allows centralized continuous long-distance support of patients, which can improve the quality of care, reduce the hazards associated with oral corticosteroids tapering, and can prevent drug-induced morbidity and mortality," explained Dr Simon Hashimo, research fellow from the department of respiratory medicine of the University of Amsterdam who lead the research.

While it was known that in patients with milder asthma, such programs had shown success, patients with severe asthma had yet been studied.

Dr Hashimoto and colleagues designed a prospective, randomized, parallel, multicenter study with 89 patients with severe asthma study to test the hypothesis that a new internet-based strategy including daily home monitoring of symptoms, lung function, FENO, and regular feedback by an internet asthma nurse, would lead to a significant reduction of corticosteroid consumption without worsening of asthma control or asthma-related quality of life. In total, 89 patients were randomized to two tapering strategies: usual care, or internet-supported with daily monitoring of FENO, FEV1 and symptoms.

For those assigned to the internet-supported strategy, each patient had a password used to log in to a secure site where they recorded daily symptoms, lung function values, FENO value and dose of medicine that they took in the day. The values were controlled every day by a specialized asthma nurse and once a week patients received instructions about the dose of oral corticosteroids they should use. The process took about 5 minutes per day for the patient, and was well accepted. Patients could also contact the asthma nurse via the website or email in the event of questions or problems.

The researchers found that among patients assigned to the internet-supported strategy, cumulative 6-month dosing of OCS was significantly lower. These patients had had years of continuous use of oral corticosteroids and a long history of attempts to taper their maintenance prednisone dose without success. This strategy offers them new hope that they can safely reduce the deleterious long-term side effects of prednisone.

The findings were presented at the American Thoracic Society 2010 International Conference in New Orleans.

Courtesy of FirstScience.com

A further successful trial of the system was conducted at the leiden University Medical Centre - click here for a report in Science Daily. The trial was reported in Respiratory Medicine
Victor Van der Meer, Henk F Van Stel, Moira J Bakker, Albert C Roldaan, Willem JJ Assendelft, Peter J Sterk, Klaus F Rabe, Jacob K Sont and Smashing Study Group. Weekly self-monitoring and treatment adjustment benefit patients with partly controlled and uncontrolled asthma: an analysis of the SMASHING study.

Click here for more research on possible treatments for asthma

First Published in May 2010

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