The purpose of a large-scale study by van der Meer and colleagues was to evaluate the effectiveness of Internet-based asthma self-management in a randomized, controlled trial. The study was conducted in 37 general practices and one academic outpatient department in the Netherlands. There were 200 adults with asthma who were treated with inhaled corticosteroids for three months or more during the previous year and who had access to the Internet. Outcome measures included asthma-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. Participants 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. Results showed that asthma-related quality of life improved by 0.56 and 0.18 points in the Internet and usual care groups, respectively. An improvement of 0.5 point or more occurred in 54% and 27% of Internet and usual care patients, respectively. Asthma control improved more in the Internet group than in the usual care group. At 12 months, 63% of Internet patients and 52% of usual care patients reported symptom-free days in the previous 2 weeks. Prebronchodilator FEV1 changed with 0.24 L and -0.01 L for Internet and usual care patients, respectively. Exacerbations did not differ between groups.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: The authors concluded that Internet-based self-management resulted in improvements in asthma control and lung function but did not reduce exacerbations. Improvement in asthma-related quality of life was slightly less than clinically significant.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: The large-scale study from the Netherlands again pointed out the increasing importance of the Internet in strengthening self-management behaviors. This resulted in improvements in asthma control and lung function, although the number of asthma attacks remained the same in the intervention and control groups. While not statistically significant, the improvement in asthma-related quality of life is encouraging.

V van der Meer et al. Internet-based self-management plus education compared with usual care in asthma: a randomized trial. Annals of Internal Medicine, 2009;151:110-120.