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Original Article


Clinical Efficacy of Web-Based Versus Standard Asthma Self-management


L Araújo,1 T Jacinto,3,4 A Moreira,1,2,3 MG Castel-Branco,2 L Delgado,1,2 A Costa-Pereira,3,4 J Fonseca2,3,4

1Serviço de Imunologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
2Serviço de Imunoalergologia, Hospital de S. João, EPE, Porto, Portugal
3Ciências de Informação e Decisão em Saúde, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
4CINTESIS – Centro de Investigação em Tecnologias e Sistemas de Informação em Saúde, Faculdade de Medicina da Universidade do Porto, Porto, Portugal

J Investig Allergol Clin Immunol 2012; Vol. 22(1):28-34



Background: Guided self-management is an important component of asthma care. Most trials have evaluated paper-based strategies. The effectiveness of new communication technologies remains uncertain.

Objectives: To compare the feasibility and clinical outcomes of a standard paper-based asthma self-management strategy with web-based strategies.

Methods: In a crossover trial, 21 patients using inhaled corticosteroids and long-acting ß2-agonists (mean [SD] age 29 [10] years) were randomly assigned to use a sequence of web-based and paper-based diary and action plan. Quality of life, asthma control, lung function, and airway inflammation were assessed using the Asthma Life Quality Questionnaire (ALQ), Asthma Control Questionnaire (ACQ-5), Mini Asthma Quality of Life Questionnaire (Mini AQLQ), and office spirometry. The ratio of forced expiratory volume in the first second of expiration (FEV1) to peak expiratory fl ow (PEF) rate (PiKo-1) and fraction of exhaled nitric oxide (FENO) were monitored. The main clinical outcomes were asthma control and FENO. Quality of data and adherence to monitoring tools were the main process outcomes.

Results: Significant improvements were observed in the AQL and ACQ scores, although lung function did not change. FENO was significantly reduced only after a web-based strategy but a significant period effect occurred (P=.006). There were no differences in clinical outcomes between web-based and paper-based management. No intervention-related adverse effects were observed. Adherence seemed higher with the paper-based strategy (P<.001). However, paper data were unreliable when compared to automatic daily electronic FEV1/PEF records. Twelve patients were very interested in continuing self-management with the web-based approach compared with 2 in using paper tools (P=.002).

Conclusions: Web-based management was feasible, safe, and preferred by patients. Short-term outcomes were at least as good, and data quality was improved.

Key words: Asthma. Crossover. Internet. Self-management.