Asthma care improved in first ever controlled trial of telemonitoring

The first ever randomized controlled trial of telemonitoring medication use among asthma patients has rendered encouraging results. The study demonstrates the potential for e-health interventions to provide tailored medical management of chronic disease.

This 1-year study followed 99 Dutch patients selected from a primary care setting. Patients self-reported breathing measurements from a handheld device every week, via a web site or a text message as part of a 7-question evaluation of asthma symptom control. (The questionnaire was validated, meaning it had been shown in previous research to be an accurate measure of symptom control.) Instantaneous responses advised patients on how to adjust, or continue with their current treatment. Participants were broken up into three groups: those whose asthma symptoms were well controlled, partly controlled, or uncontrolled when the trial started.

They were compared to a 100 roughly similar asthma patients who did not receive the weekly online treatment adjustments. The researchers were able to answer a few interesting questions. Firstly about compliance: How likely are patients to stick to a weekly reporting regimen? In the first month 88% of patients reported in weekly. By month 7 compliance had dropped to 60%, where it remained through month 12. For effectiveness in controlling asthma symptoms, the study found that after 12 months, internet-supported patients whose symptoms were partly or uncontrolled at the outset experienced significant improvements in symptom scores compared to the control group, but were not using more or more powerful medicines, such as inhaled steroids. Use of those medications tended to increase in the first three months among the intervention group, then taper off thereafter.

This study is small, and certainly not proof of effectiveness. But it's encouraging to see an automated system successfully rely on basic technologies improve chronic disease management. Moreover, the ability for such automated technologies to provide individualized medical advice, potentially to a wide spectrum of patients, is also fascinating, and may reduce some potential concerns that such "robo-care" can't provide personalized care.

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