Background It is recognised that some 45% of the population exhibit poor asthma control. Over 90% of the population possess a mobile phone (>70% over 60 years of age). Mobile technology potentially addresses the barriers of low expectations and poor concordance which are factors in poor asthma control.
Hypothesis Using mobile phone recording of symptoms, lung function and medication use with instant feedback of asthma control, would improve control compared to using paper diaries.
Trial design A 6-month researcher-blinded randomised controlled trial
Setting UK primary care
Method Using central randomisation, we allocated patients ≥12 years of age with poorly controlled asthma (ACQ>1.5) to either mobile phone or paper-based monitoring. Clinical care was provided by practice asthma nurses in accordance with SIGN/BTS guidelines. Patients were reviewed monthly until control was achieved. A researcher, blinded to allocation assessed outcomes at 3 m and 6 m. Primary outcome measure: change in Asthma Control Questionnaire score between baseline and 6 months.
Results We randomised 288 patients from 32 practices (209 completed). Baseline characteristics of both groups were similar. Intention to treat analysis, before breaking the randomisation code, showed that control in both groups improved significantly and to a similar extent. ACQ: Group 1 (n=110) Baseline 2.17, 6m 1.25: Group 2 (n=99) Baseline 2.33, 6m 1.17. Mean (95% CI) improvement in ACQ: Group 1 (n=110) 0.84 (0.67, 1.02), Group 2 (n=99) 0.94 (0.77, 1.11) both p<0.001. Between group p=0.434 ns. Approximately 70% in each group improved by ≥0.5 (minimal clinically important difference).
|ACQ6 score||Group 1(n=110)||Group 2(n=99)||Between group p value|
|Baseline, median (IQR)||2.17 (1.67–2.67)||2.33 (1.67–2.67)||0.441|
|6 months, median (IQR)||1.25 (0.67–1.83)||1.17 (0.67–1.83)||0.995|
|Median difference (IQR)||0.83 (0.17–1.50)||0.83 (0.33–1.33)||0.586|
|Within group p value (Wilcoxon)||<0.001||<0.001|
|Mean difference (95% CI)||0.84 (0.67 to 1.02)||0.94 (0.77 to 1.11)||0.434|
|Within group p value (t-test)||<0.001||<0.001|
|MID*, n (%)||0.652|
|Improvement = MID||74 (67.3)||73 (73.7)|
|Improvement < MID||20 (18.2)||16 (16.2)|
|Deterioration < MID||6 (5.5)||5 (5.5)|
|Deterioration = MID||10 (9.1)||5 (5.1)|
Conclusion Both groups demonstrated significant improvement in asthma control from baseline. Use of mobile phone technology provided no additional benefit over paper diaries.
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