Online monitoring may help cut steroid use in kids with asthma

By Lisa Rapaport

(Reuters Health) - Monitoring asthma symptoms online once a month may help children reduce their use of steroids, particularly when routine clinic visits are infrequent, a study suggests.

"By monitoring the asthma control every month, there are more contacts between patient and health care provider, the child or parent is more aware of the asthma control, and inhaled steroids can be changed more frequently," senior author Dr. Marielle Pijnenburg, a pediatric pulmonologist at Erasmus University Medical Center in the Netherlands, said by email.

As reported online March 30 in Thorax, Pijnenburg and colleagues studied 272 children with asthma, ages 4 to 18, who had been using inhaled corticosteroids for at least three months.

The children were randomly assigned to continue with standard care - clinic visits every four months - or to supplement this with monthly web-based monitoring or a test for nitric oxide in their breath at each checkup.

Over the 12-month study, the children assigned to monthly online monitoring completed a web-based version of the same symptom questionnaire used by doctors in the clinic. Then, they received treatment advice by email from a nurse or a researcher within three days. Steroid doses could be adjusted monthly.

Participants in the nitric oxide testing group got this screening every four months when they went to the clinic. Their steroid doses could be adjusted at each of those visits.

Children who received standard care could also have their medication adjusted every four months, at each clinic visit, and they responded to the same questions used for online symptom monitoring.

The main goal of the study was to see if web-based monitoring or nitric oxide testing could lead to more symptom-free days than standard clinic visits alone, but there was no significant difference among the groups.

But researchers also looked at steroid use over the course of the study and found a significantly larger reduction for children in the online monitoring group.

"The one silver lining here is that the monitoring allowed tapering of steroid dosage without loss of control," Dr. Richard Moss, of Stanford University in Palo Alto, California, said by email. Moss, who wasn't involved in the study, noted that the main role of technology in asthma management would be to support rather than replace in-person visits with clinicians.

One advantage of the web may be its immediacy, said Dr. Andre Schultz, a respiratory specialist at Princess Margaret Hospital for Children in Perth, Australia. At clinic visits, it can be challenging to ask children or their parents to recall what symptoms have been like over the past several weeks, Schultz, who wasn't involved in the study, said by email.

The online questionnaire may have led to a greater reduction in steroid use than the nitric oxide test because this screening doesn't work for every patient, said Dr. Mark Anselmo, a pediatrician at Bumming School of Medicine at the University of Calgary in Canada. While non-invasive, the nitric oxide test has failed to detect asthma symptoms in some children hospitalized for asthm, he said by email.

The fact that kids with monthly online monitoring received lower inhaled steroid doses suggests that clinicians could intervene more often between visits to help children reduce medication doses, said Dr. Gregory Sawicki, a respiratory disease specialist at Boston Children's Hospital and Harvard University.

Web-based or mobile interventions "might allow for more real-time monitoring of symptoms and could facilitate communication with healthcare providers to tailor therapy to maintain asthma control and reduce the risk of exacerbations," Sawicki, who wasn't involved in the study, said by email.

"Similar monitoring of disease outcomes or symptoms using web-based technology could be considered for many chronic diseases of childhood," he added.

SOURCE: http://bmj.co/1CZoVac

Thorax 2015.

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