Computer program helps asthma symptoms

Using a computer program to monitor asthma symptoms and adjust treatment can help people with poorly-controlled asthma reduce their symptoms, researchers have found. But the program is less helpful for those whose asthma is already well under control.

What do we know already?

The aim of treatment for asthma is to stop attacks of asthma symptoms, such as breathlessness or coughing fits. If you get few symptoms, doctors say you have well-controlled asthma, because the medicine controls the symptoms. But many people find that treatment doesn’t completely control their asthma, and are still bothered by symptoms, perhaps when they exercise.

Adjusting your medicine can make a difference in how well your asthma is controlled. For example, taking an extra puff of your steroid inhaler each day might help if you’ve been getting more symptoms. And some people with well-controlled asthma (they don’t get symptoms) may be able to cut down the amount of medicine they take.

The difficulty is knowing exactly when to do what. Many people with asthma only see their doctor once or twice a year, unless they are having particular problems. So, a computer program that can advise you on how to adjust your medicine to take account of your symptoms sounds like a good idea.

Researchers previously carried out a one-year study looking at 200 people with asthma. People had their asthma symptoms and lung capacity measured at the start of the study, after three months, and again at the end of the study. Half the group filled in an online questionnaire about their symptoms every week and had an instant email back to say whether they needed to adjust their medicine up or down, or to advise them to see the asthma nurse if their symptoms were very bad. The other half of the group had usual care from their GP or asthma nurse.

Overall, the people using the computer program showed a slight improvement in asthma symptoms compared with the usual care group. But the improvement wasn’t big enough to be sure it was making a real difference to their symptoms.

However, if your asthma is already well controlled, a program to help you get it under control is unlikely to make much difference. So, the researchers looked at their figures again, dividing the groups into those who had good asthma control, those whose asthma was partly controlled, and those who had uncontrolled asthma (meaning they often had symptoms). They looked to see what difference the program had made to these sub-groups.

What does the new study say?

Unsurprisingly, the people with well-controlled asthma at the start of the study had well-controlled asthma at the end of the study. Their symptoms hadn’t changed compared with the usual care group, because they rarely got symptoms anyway. However, the people on the program had been able to reduce the amount of steroid drugs they took by the end of the year.

For people who had partly controlled or uncontrolled asthma, the program made a real difference. By the end of the year, both groups had improved at least half a point on the 7-point asthma scale. This is a big enough improvement to make a real difference to the amount and severity of someone’s asthma symptoms. The group with uncontrolled asthma had improved almost a whole point, compared with the people who’d had usual care.

Both these groups increased the amount of steroid medicine they took in the first three months of the study, then were gradually able to reduce it. By the end of the year, they were taking about the same amount of medication as the usual care group, but their symptoms had improved. This suggests that it takes an increase in steroids to get symptoms under control at first, but then less to keep them under control in the long term.

How reliable are the findings?

We need to be cautious about re-analysis of figures from previous studies, because the researchers could look at the figures and work out how to re-do the analysis to put their treatment in the best light. It’s more reliable if researchers state, before the study begins, how they are going to look at sub-groups of people taking part.

However, it is logical to look separately at groups of patients who began the study with different levels of asthma control. And the study was big enough for these sub-groups to show fairly reliable results.

Where does the study come from?

The study was done by researchers from Leiden University and Amsterdam University in the Netherlands. It was published in the journal Respiratory Research, owned by the Biomed Central online publishing group.
What does this mean for me?

If you have asthma and are still bothered by symptoms, this study shows that adjusting your medicine may help you get on top of those symptoms. However, the computer program from the study is not widely available yet, so you’ll need to talk to your GP or asthma nurse about the best way of keeping on top of symptoms. You could discuss how best to record your symptoms, and how to adjust your medicine when you get symptoms.

What should I do now?

If you are getting asthma symptoms despite taking your medicine as agreed with your doctor or nurse, you should make an appointment to discuss changing your treatment. There are other things to consider, though. In the study, the people with uncontrolled asthma were much more likely to smoke, and less likely to fill in the asthma questionnaire every week during the study. Smoking will always make your asthma worse, and the medicine can only help if you take it properly. Giving up smoking and taking your medicine as agreed gives you a good start if you want your symptoms to improve.


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