JMIR Publications

ABSTRACT

Background:

In patients with severe asthma, high-altitude climate treatment has shown to improve asthma control. However, asthma symptoms and limitations may increase after finishing inpatient rehabilitation programs and once returning to sea level.

Objective:

We assessed the effectiveness of a patient tailored internet-based self-management (IBSM) support in addition to usual care after finishing high-altitude climate treatment.

Methods:

We performed a randomised controlled trial with a 1-year follow up in patients from a high-altitude asthma centre in Davos, Switzerland. At the end of a 12-week multi-disciplinary rehabilitation program sixty-two asthmatic adults were randomised to receive either internet-based self-management support (IBSM) in addition to usual care (N=33), or usual care only after discharge (N=29). Endpoints were changes in asthma-related quality of life (AQLQ, the higher the better) and asthma control (ACQ, the lower the better), both with a minimally important difference of 0.5 points.

Results:

Asthma-related quality of life and asthma control declined over time in the usual care strategy, whereas there was less decline in the intervention group. In both endpoints, mixed-model analysis showed a significant positive effect in favour of IBSM during follow-up (AQLQ difference 0.39 (0.092 to 0.69); P = .01; ACQ difference -0.50 (-0.86 to -0.15);, P = .006), which was especially found in patients with uncontrolled asthma at discharge (AQLQ difference 0.59 (0.19 to 0.99); P = .003; ACQ difference -0.73 (-1.18 to -0.28), P = .002).

Conclusions:

IBSM support was associated with a smaller decline in QoL and asthma control, especially in patients with lower asthma control after completing the high-altitude climate treatment. Support of IBSM in adults with severe asthma seems feasible and effective to maintain quality of life and asthma control. Clinical Trial: Netherlands Trial Register (NTR1995)