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Monitoring strategies in children with asthma: a randomised controlled trial
Sandra Voorend-van Bergen1, Anja A Vaessen-Verberne2, Hein J Brackel3
1Department of Paediatrics, Division Paediatric Respiratory Medicine, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, the Netherlands.
Insights
Web-based asthma monitoring using the Asthma Control Test (ACT) allowed for significant reductions in inhaled corticosteroid (ICS) use while maintaining symptom control. This approach offers a promising strategy for managing childhood asthma effectively.
Area of Science:
- Pediatric Pulmonology
- Clinical Trial Research
- Asthma Management
Background:
- Asthma guidelines emphasize monitoring, yet many children have poorly controlled asthma.
- Optimal monitoring strategies for pediatric asthma remain unclear.
Purpose of the Study:
- To compare web-based monthly ACT monitoring and 4-monthly FENO monitoring against standard care (SC) for improving asthma outcomes.
- To evaluate the efficacy of different asthma monitoring strategies in children.
Main Methods:
- A 1-year, randomized controlled trial involving children aged 4-18 with asthma.
- Three groups: web-based ACT monitoring, FENO monitoring, and standard care.
- Primary endpoint: change in proportion of symptom-free days (SFD).
Main Results:
- No significant difference in SFD changes between the web, FENO, and SC groups.
- Web-based ACT monitoring led to a significant reduction in inhaled corticosteroid (ICS) dosage.
- Asthma control (ACT and SFD) was maintained despite ICS reduction in the web group.
Conclusions:
- The change in symptom-free days did not differ significantly across the monitoring strategies.
- Web-based ACT monitoring facilitates substantial ICS reduction without compromising asthma control.
- This study highlights the potential of digital health tools in asthma management.
Background:
Asthma guidelines recommend monitoring of asthma control. However, in a substantial proportion of children, asthma is poorly controlled and the best monitoring strategy is not known.
Objectives:
We studied two monitoring strategies for their ability to improve asthma outcomes in comparison with standard care (SC): web-based monthly monitoring with the (Childhood) Asthma Control Test (ACT or C-ACT) and 4-monthly monitoring of FENO.
Methods:
In this randomised controlled, partly blinded, parallel group multicentre trial with a 1-year follow-up, children aged 4-18 with a doctor's diagnosis of asthma treated in seven hospitals were randomised to one of the three groups. In the web group, treatment was adapted according to ACT obtained via a website at 1-month intervals; in the FENO group according to ACT and FENO, and in the SC group according to the ACT at 4-monthly visits. The primary endpoint was the change from baseline in the proportion of symptom-free days (SFD).
Results:
Two-hundred and eighty children (mean age 10.4 years, 66% boys) were included; 268 completed the study. Mean changes from baseline in SFD were similar between the groups: -2.1% (web group, n=90), +8.9% (FENO group, n=91) versus 0.15% (SC, n=87), p=0.15 and p=0.78. Daily dose of inhaled corticosteroids (ICS) decreased more in the web-based group compared with both other groups (-200 μg/day, p<0.01), while ACT and SFD remained similar.
Conclusions:
The change from baseline in SFD did not differ between monitoring strategies. With web-based ACT monitoring, ICS could be reduced substantially while control was maintained.
Trial Registration Number:
NTR 1995.
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