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Telehealthcare for asthma
Open accessAbstract
BACKGROUND: Healthcare systems internationally need to consider new models of care to cater for the increasing numbers of people with asthma. Telehealthcare interventions are increasingly being seen by policymakers as a potential means of delivering asthma care. We defined telehealthcare as being healthcare delivered from a distance, facilitated electronically and involving the exchange of information through the personalised interaction between a healthcare professional using their skills and judgement and the patient providing information. OBJECTIVES: To assess the effectiveness of telehealthcare interventions in people with asthma. SEARCH STRATEGY: We searched in the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, AMED, and PsycINFO; this was supplemented by handsearching of respiratory journals. We also searched registers of ongoing and unpublished trials. SELECTION CRITERIA: We selected completed randomised controlled trials of telehealthcare initiatives aiming to improve asthma care. DATA COLLECTION AND ANALYSIS: Two review authors independently appraised studies for inclusion and extracted data and performed meta-analyses. We analysed dichotomous variables to produce an odds ratio (OR) and continuous variables to produce a mean difference. MAIN RESULTS: We included 21 trials in this review. The 21 included studies investigated a range of technologies aiming to support the provision of care from a distance. These included: telephone (n = 9); video-conferencing (n = 2); Internet (n = 2); other networked communications (n = 6); text Short Messaging Service (n = 1); or a combination of text and Internet (n = 1). Meta-analysis showed that these interventions did not result in clinically important improvements in asthma quality of life (minimum clinically important difference = 0.5): mean difference in Juniper's Asthma Quality of Life Questionnaire (AQLQ) 0.08 (95% CI 0.01 to 0.16). Telehealthcare for asthma resulted in a non-significant increase in the odds of emergency department visits over a 12-month period: OR 1.16 (95% CI 0.52 to 2.58). There was, however, a significant reduction in hospitalisations over a 12-month period: OR 0.21 (95% CI 0.07 to 0.61), the effect being most marked in people with more severe asthma managed predominantly in secondary care settings. AUTHORS' CONCLUSIONS: Telehealthcare interventions are unlikely to result in clinically relevant improvements in health outcomes in those with relatively mild asthma, but they may have a role in those with more severe disease who are at high risk of hospital admission. Further trials evaluating the effectiveness and cost-effectiveness of a range of telehealthcare interventions are needed.
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In the citing paper
“Meta-analyses showed no significant improvement in emergency department use or hospitalization at 3 months, but a significant reduction in hospitalizations compared with usual care at 12 months.”
From Telehealth Interventions to Support Self-Management of Long-Term Conditions: A Systematic Metareview of Diabetes, Heart Failure, Asthma, Chronic Obstructive Pulmonary Disease, and Cancer (2017) · cites this paper as [63]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“In asthma there was significant reduction in hospitalisations over a 12 month period across four studies with a variety of telehealthcare interventions, including web-based diary and interaction with professionals, telephone calls from a nurse educator, telemonitoring with oversight for severe asthma and electronic diary with email or telephone follow up from a physician (risk ratio of 0.3 (95% C.”
From The Impact of Telehealthcare on the Quality and Safety of Care: A Systematic Overview (2013) · cites this paper as [61]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“In asthma, improvements in peak flow rates and symptoms were not consistently demonstrated with daily interactive monitoring and educational tools via the Internet [60], [61].”
From The Impact of Telehealthcare on the Quality and Safety of Care: A Systematic Overview (2013) · cites this paper as [61]
In the citing paper
“Some studies reported improvements in symptom scores; however, most showed no benefit.”
In the citing paper
“A total of 8 reviews assessed the impact on asthma control through symptom scores, quality of life, or unscheduled health care [20,24,27,28,36,61-63].”
In the citing paper
“The highest weighted of these each scored 2 stars [24,27,62,63], including 3 narrative syntheses and 1 meta-analysis.”
In the citing paper
“McLean et al analyzed a wide range of telehealth interventions, including structured telephone support, education support, telemonitoring, and action plan components [63].”
In the citing paper
“The authors concluded that benefits were unlikely in mild asthma but that those at higher risk of hospitalization may benefit.”
In the citing paper
“This was the most commonly described telehealth component in the included systematic reviews and was associated with improved clinical outcomes in diabetes and heart failure [33,35,36,38,42,44,54,58]; however, findings for asthma and COPD were mostly neutral or inconsistent [61-63,65,66,68,69].”
In the citing paper
“Interventions with multiple components, or more intensive interventions, may be associated with greater benefits [30,53,63,68].”
In the citing paper
“There was some evidence for reduced hospitalization with telehealth interventions in more severe asthma and COPD [63,68]”
In the citing paper
“However, none of these reviews focused on the role of 2-way asynchronous communication between patients and health care professionals.”
From Effectiveness and Acceptability of Asynchronous Digital Health in Asthma Care: Mixed Methods Systematic Review (2024) · cites this paper as [20]
In the citing paper
“existing reviews have noted a large degree of variation in the way telehealth is delivered in studies and to whom and with what it is compared (Jaana 2009; McLean 2010), and have been limited for this reason in the conclusions that could be drawn.”
From Home telemonitoring and remote feedback between clinic visits for asthma (2016) · cites this paper as McLean 2010
In the citing paper
“McLean 2010 looked at all 'telehealth' interventions for asthma regardless of their constituent parts or comparators used, and found 21 studies.”
From Home telemonitoring and remote feedback between clinic visits for asthma (2016) · cites this paper as McLean 2010
In the citing paper
“McLean 2010 noted the clinical heterogeneity and concluded that telehealth interventions are not likely to be of benefit for patients with relatively mild asthma.”
From Home telemonitoring and remote feedback between clinic visits for asthma (2016) · cites this paper as McLean 2010
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Metadata
- Authors
- McLean, S., Chandler, D., Nurmatov, U., Liu, J. L., Pagliari, C., Car, J., & Sheikh, A.
- Affiliations
- University of Edinburgh (GB)
- University of Dundee (GB)
- University of Ljubljana (SI)
- Venue
- Cochrane Database of Systematic Reviews
- Publisher
- Wiley
- Published
- 2010-10-06
- Volume
- 2012
- Issue
- 8
- Pages
- CD007717-CD007717
- ISSN
- 1361-6137 (ISSN-L)
- 1465-1858
- PMC
- PMC8936049
- OpenAlex
- W2103999787
- Cited by
- 119
- References
- 101
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 3 · 2023: 6 · 2022: 4 · 2021: 9 · 2020: 8 · 2019: 6 · 2018: 4 · 2017: 8 · 2016: 11 · 2015: 11 · 2014: 17 · 2013: 8 · 2012: 12
- FWCI
- 1.25
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Cochrane Database of Systematic Reviews (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, other-oa)
- Discovery Research Portal (University of Dundee) (submittedVersion, other-oa)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion)
- Research Publications (Maastricht University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Asthma and respiratory diseases
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- telemedicine, asthma, remote patient monitoring, telephone care, videoconferencing, asthma quality of life, hospitalization, emergency department visits, severe asthma, secondary care
- MeSH terms
- Asthma, Humans, Telephone, Randomized Controlled Trials as Topic, Telemedicine, Internet
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