Virtual Asthma Clinic for Children.

Background:

Pediatric asthma management has evolved considerably over the last decades. In addition to published guidelines and improved modes of administration for medication, much attention is now spent on adherence to treatment, quality of life, and self-management. Web-based digital tools have been shown to improve asthma knowledge, management, and outcome when added to usual care. It has not been investigated whether these tools may substitute regular visits to the outpatient clinic, and still improve asthma outcome in children and adolescents.



Objective:

To assess whether asthma control can be improved through a virtual asthma clinic for children with asthma, while reducing the regular visits to the outpatient clinic by 50%.



Study design:

Prospective, national, multicenter (n=7) randomized trial in which asthma management of children with allergic asthma, aged 6-18 years, through a virtual clinic will be compared with usual care. Children will be randomized into usual care (n=105) or partly digital care (n=105) through the virtual asthma clinic. Asthma treatment is in agreement with Dutch asthma management guidelines, but to correct for subtle differences between centers, randomization will be performed per center.

The primary endpoint is the number of symptom free days per month at the end of the study.

Secondary endpoints are: number of exacerbations, hospital admissions, unscheduled visits, and adherence to treatment, daily dose of ICS, quality of life, asthma control score and patient empowerment. Furthermore, cost-effectiveness will be analyzed.

The introduction of a virtual asthma clinic may improve the number of asthma free days in children with asthma while the number of visits to the outpatient clinic is decreased by 50%.

1. Start inclusion: September 2011;

2. Stop inclusion: August 2011.

Randomized allocation tot usual care (outpatient clinic vist every 4 months) or access to virtual asthma clinic (outpatient clinic visits every 8 months).



The virtual asthma clinic consist of a website, accesible for all patients, their parents and their doctor’s. It has three modules:

1. An extended educational/informational module with backgroundinformation on asthma en used medication along with instructive video’s;

2. A forum on which questions can be asked and tips can be shared;

3. A shielded privat module on which the personal treatment (maintenance and attack treatment) can be consulted and on which de patient or parent freely, easily and always can communicate with the doctor. Answers are given within 24 hours on working days.

Patients receive an email every 4 weeks requesting to fill in the Astma Controle Test online, a short questionnaire, so doctor’s can monitor the degree of asthma. Results are online available for patients. When asthma control is insufficient, the treatment team will contact the patient for discussion and, if necessary, extra measurements are taken. The current contactdetails can also be found in this section.