Asthma Self-management Via Application of Telehealth
Asthma Self-management Via Application of Telehealth
Objectives:

 The disease being studied is asthma. The main objective of this study is to assess the
 feasibility of the recruitment goals and also the logistical issues related to use of
 tele-health technology in developing electronic asthma action plan (eAAP) and communicate
 with asthma patients in a time period of 24 months. The goals are: 1) enable asthma patients
 to self-manage their asthma symptoms. The secondary, 2) help care providers to intervene
 appropriately based on the patient's health status. The secondary objective is to explore the
 cost-benefit and cost-effectiveness of the proposed technology. Our research group proposes
 to complete a feasibility study, with an interim analysis for a formal power calculation and
 then acquire ethics to report these results and study design with anticipated publication
 prior to proceeding with a full randomized controlled trial to assess the efficacy of this
 intervention. The outcome measure will be assessed and data will be presented in a 24-month
 time frame.

 Aims and goals:

 The main aim of our proposed study is to assist asthma patients to practice asthma
 self-management at home that will eventually enable them to control their asthma, and
 specifically, prevent asthma exacerbation. Therefore, the ultimate goal of our proposed study
 is to improve patient health outcome via enhancing patient-physician interaction and using a
 more practical asthma action plan model (eAAP) that could be followed easily by the patient
 and their doctor.

 Our hypothesis is that asthma patients who have access to the electronic online action plan
 complimented by weekly text messages to reinforce adherence will have a reduced rate of
 asthma exacerbation. We further hypothesize that these subjects will have an improvement in
 secondary measures including quality of life, better asthma control and patient satisfaction.
 We also anticipate that such an approach in asthma management will be cost-effective as
 outlined below.
In our study design we propose to use a web-based application and inform asthma patients
 through weekly Text Message (SMS) reminders to take their controller medication regularly and
 also a message to visit the web-based e-AAP and assess the current level of asthma control.
 This will be a two-way interaction and personalized feedback protocol to monitor patients at
 home and during daily activities. We will use an adequate sample size to provide an interim
 analysis of efficacy and the subsequent total number of subjects that will need to be
 enrolled. Each patient (in the relevant group, as explained below) will have his/her own
 profile, which will enable us to send and receive personalized (exchange) information using a
 web application process via cell phones. This approach will allow interaction between patient
 and asthma care counselor/ provider aiming to improve asthma control.

 This study will test the hypothesis that using mobile phone reminder messages and web-based
 monitoring, as part of a structured care plan, will improve clinical outcomes; namely
 reduction in the rate of exacerbation, in patients with asthma. We also aim to explore the
 cost-effectiveness of this technology. Our research group proposes to complete a feasibility
 study, with an interim analysis for a formal power calculation and then acquire ethics to
 report these results and study design with anticipated publication prior to proceeding with a
 full randomized controlled trial to assess the efficacy of this intervention. We predict that
 using a combination of Internet and SMS messaging technology will empower patients to manage
 their asthma and eventually prevent asthma exacerbation based on their personalized action
 plan as well as a SMS application. We plan to compare the web-based/SMS reminder method with
 written action plan approach in a 24-month time frame, as explained later in this proposal.
Inclusion Criteria:

 1. Physician diagnosed asthma.

 2. A history of an asthma exacerbation requiring oral corticosteroids or admission to
 Emergency Department/hospital in the previous year.

 3. Ability to understand English and follow the material included in the two different
 interventions.

 4. Ownership of a mobile phone with the capacity to support text messaging.

 5. Patients on maintenance inhaled corticosteroids alone or with a combination inhaler.
 Subjects on other controller therapies will not be excluded as long as they fulfill
 these inclusion criteria.

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 Exclusion Criteria:

 1. Inability to provide written informed consent.

 2. A history of smoking cigarettes for greater than ten pack years.

 3. Not owning a mobile cell phone.

 4. Subjects only taking a reliever medication and on no controller medication.

 5. A history of significant co morbid disease judged by the investigator to preclude
 enrolment.

 6. A history of an asthma exacerbation requiring oral corticosteroids in the previous six
 weeks.

 7. Plans to move out of the study area in the next year. -