• Victor van der Meer, Moira J Bakker, Wilbert B van den Hout, Klaus F Rabe, Peter J Sterk, Job Kievit, Willem J J Assendelft, Jacob K Sont, and SMASHING (Self-Management in Asthma Supported by Hospitals, ICT, Nurses and General Practitioners) Study Group.
• Leiden University Medical Center, Leiden, The Netherlands. v.van_der_meer@lumc.nl
• Ann. Intern. Med. 2009 Jul 21;151(2):110-20.

BackgroundThe Internet may support patient self-management of chronic conditions, such as asthma.ObjectiveTo evaluate the effectiveness of Internet-based asthma self-management.DesignRandomized, controlled trial.Setting37 general practices and 1 academic outpatient department in the Netherlands.Patients200 adults with asthma who were treated with inhaled corticosteroids for 3 months or more during the previous year and had access to the Internet.MeasurementsAsthma-related quality of life at 12 months (minimal clinically significant difference of 0.5 on the 7-point scale), asthma control, symptom-free days, lung function, and exacerbations.InterventionParticipants were randomly assigned by using a computer-generated permuted block scheme to Internet-based self-management (n = 101) or usual care (n = 99). The Internet-based self-management program included weekly asthma control monitoring and treatment advice, online and group education, and remote Web communications.ResultsAsthma-related quality of life improved by 0.56 and 0.18 points in the Internet and usual care groups, respectively (adjusted between-group difference, 0.38 [95% CI, 0.20 to 0.56]). An improvement of 0.5 point or more occurred in 54% and 27% of Internet and usual care patients, respectively (adjusted relative risk, 2.00 [CI, 1.38 to 3.04]). Asthma control improved more in the Internet group than in the usual care group (adjusted difference, -0.47 [CI, -0.64 to -0.30]). At 12 months, 63% of Internet patients and 52% of usual care patients reported symptom-free days in the previous 2 weeks (adjusted absolute difference, 10.9% [CI, 0.05% to 21.3%]). Prebronchodilator FEV1 changed with 0.24 L and -0.01 L for Internet and usual care patients, respectively (adjusted difference, 0.25 L [CI, 0.03 to 0.46 L]). Exacerbations did not differ between groups.LimitationThe study was unblinded and lasted only 12 months.ConclusionInternet-based self-management resulted in improvements in asthma control and lung function but did not reduce exacerbations, and improvement in asthma-related quality of life was slightly less than clinically significant.Primary Funding SourceNetherlands Organization for Health Research and Development, ZonMw, and Netherlands Asthma Foundation.

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