Home telemonitoring and remote feedback between clinic visits for asthma

Area of Science:

• Respiratory Medicine
• Digital Health
• Evidence Synthesis

Background:

• Asthma is a chronic respiratory disease characterized by airway narrowing, inflammation, and mucus production, leading to significant morbidity and mortality.
• Self-management, guided by healthcare professionals, is crucial for controlling asthma symptoms and preventing exacerbations.
• Telemonitoring technologies enable patients to remotely measure lung function and symptoms, sharing data with providers for feedback between clinic visits, potentially improving health outcomes.

Purpose of the Study:

• To evaluate the efficacy and safety of home telemonitoring with healthcare professional feedback compared to usual care for asthma management.
• To assess the impact of telemonitoring on asthma exacerbations, emergency department visits, hospitalizations, and overall asthma control.

Main Methods:

• A systematic review and meta-analysis of parallel randomized controlled trials (RCTs) was conducted.
• Searches included the Cochrane Airways Group Specialised Register, clinicaltrials.gov, WHO portal, and reference lists, up to May 2016.
• Data from 18 RCTs involving 2268 participants (adults and children) were analyzed using random-effects models, with evidence quality rated using the GRADE approach.

Main Results:

• Telemonitoring did not significantly reduce the odds of asthma exacerbations requiring oral steroids, emergency department visits, or hospitalizations compared to usual care.
• Evidence for asthma control was imprecise, though a small, inconsistent benefit in quality of life was observed (MD 0.23, 95% CI 0.01 to 0.45).
• Some potential benefits for lung function measures were noted, but results were uncertain due to study limitations like unblinding and possible attrition bias.

Conclusions:

• Current evidence does not support the widespread adoption of telemonitoring for asthma management due to unproven benefits in symptom control and exacerbation reduction.
• Small observed benefits in quality of life are limited by study biases, and potential harms remain unevaluated.
• Larger pragmatic trials and qualitative studies are needed to determine real-world benefits and identify patient subgroups who may benefit most from telemonitoring.