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The Effects of Telemedicine on Asthma Control and Patients' Quality of Life in Adults: A Systematic Review and Meta-analysis

  • Bunchai Chongmelaxme
    Affiliations
    Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
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  • Shaun Lee
    Affiliations
    School of Pharmacy, Monash University Malaysia, Selangor, Malaysia

    Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
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  • Teerapon Dhippayom
    Affiliations
    Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
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  • Surasak Saokaew
    Affiliations
    Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand

    School of Pharmacy, Monash University Malaysia, Selangor, Malaysia

    Center of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
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  • Nathorn Chaiyakunapruk
    Affiliations
    Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand

    School of Pharmacy, Monash University Malaysia, Selangor, Malaysia

    Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia

    Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand

    School of Pharmacy, University of Wisconsin, Madison, Wis
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  • Piyameth Dilokthornsakul
    Correspondence
    Corresponding author: Piyameth Dilokthornsakul, PharmD, PhD, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, 99 Moo 9, Phitsanulok-Nakhon Sawan Road, Tha Pho, Mueang Phitsanulok, Phitsanulok 65000, Thailand.
    Affiliations
    Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand

    Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
    Search for articles by this author

      Background

      Telemedicine is increasingly used to improve health outcomes in asthma. However, it is still inconclusive which telemedicine works effectively.

      Objective

      This study aimed to determine the effects of telemedicine on asthma control and the quality of life in adults.

      Methods

      An electronic search was performed from the inception to March 2018 on the following databases: Cochrane CENTRAL, CINAHL, ClinicalTrials.gov, EMBASE, PubMed, and Scopus. Randomized controlled trials that assessed the effects of telemedicine in adults with asthma were included in this analysis, and the outcomes of interest were levels of asthma control and quality of life. Random-effects model meta-analyses were performed.

      Results

      A total of 22 studies (10,281 participants) were included. Each of 11 studies investigated the effects of single-telemedicine and combined-telemedicine (combinations of telemedicine approaches), and the meta-analyses showed that combined tele-case management could significantly improve asthma control compared with usual care (standardized mean difference [SMD] = 0.78; 95% confidence interval [CI]: 0.56, 1.01). Combined tele-case management and tele-consultation (SMD = 0.52 [95% CI: 0.13, 0.91]) and combined tele-consultation (SMD = 0.28 [95% CI: 0.13, 0.44]) also significantly improved asthma outcomes, but to a lesser degree. In addition, combined tele-case management (SMD = 0.59 [95% CI: 0.31, 0.88]) was the most effective telemedicine for improving quality of life, followed by combined tele-case management and tele-consultation (SMD = 0.31 [95% CI: 0.03, 0.59]), tele-case management (SMD = 0.30 [95% CI: 0.05, 0.55]), and combined tele-consultation (SMD = 0.27 [95% CI: 0.11, 0.43]), respectively.

      Conclusions

      Combined-telemedicine involving tele-case management or tele-consultation appear to be effective telemedicine interventions to improve asthma control and quality of life in adults. Our findings are expected to provide health care professionals with current evidence of the effects of telemedicine on asthma control and patients' quality of life.

      Key words

      Abbreviations used:

      CI (Confidence interval), DM (Diabetes mellitus), HbA1c (Hemoglobin A1c), RCT (Randomized controlled trial), SMD (Standardized mean differences)
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      References

        • World Health Organization
        Global Surveillance, Prevention and Control of Chronic Respiratory Diseases: A Comprehensive Approach.
        WHO Press, Switzerland2007
        • Global Initiative for Asthma
        Global Strategy for Asthma Management and Prevention.
        2016 (Available from:) (Accessed October 1, 2016)
        • Croisant S.
        Epidemiology of asthma: prevalence and burden of disease.
        Adv Exp Med Biol. 2014; 795: 17-29
        • World Health Organization
        Telemedicine: Opportunities and developments in Member States.
        WHO Press, Switzerland2009
        • Tulu B.
        • Chatterjee S.
        • Maheshwari M.
        Telemedicine taxonomy: a classification tool.
        Telemed J E Health. 2007; 13: 349-358
        • Lee S.W.H.
        • Chan C.K.Y.
        • Chua S.S.
        • Chaiyakunapruk N.
        Comparative effectiveness of telemedicine strategies on type 2 diabetes management: a systematic review and network meta-analysis.
        Sci Rep. 2017; 7: 12680
        • Kruse C.S.
        • Soma M.
        • Pulluri D.
        • Nemali N.T.
        • Brooks M.
        The effectiveness of telemedicine in the management of chronic heart disease—a systematic review.
        JRSM Open. 2017; 8 (2054270416681747)
        • Hernandez C.
        • Mallow J.
        • Narsavage G.L.
        Delivering telemedicine interventions in chronic respiratory disease.
        Breathe (Sheff). 2014; 10: 198-212
        • Schwartz K.A.
        • Britton B.
        Use of telehealth to improve chronic disease management.
        N C Med J. 2011; 72: 216-218
        • McLean S.
        • Chandler D.
        • Nurmatov U.
        • Liu J.
        • Pagliari C.
        • Car J.
        • et al.
        Telehealthcare for asthma: a Cochrane review.
        CMAJ. 2011; 183: E733-E742
        • Zhao J.
        • Zhai Y.K.
        • Zhu W.J.
        • Sun D.X.
        Effectiveness of telemedicine for controlling asthma symptoms: a systematic review and meta-analysis.
        Telemed J E Health. 2015; 21: 484-492
        • McLean G.
        • Murray E.
        • Band R.
        • Moffat K.R.
        • Hanlon P.
        • Bruton A.
        • et al.
        Interactive digital interventions to promote self-management in adults with asthma: systematic review and meta-analysis.
        BMC Pulm Med. 2016; 16: 83
        • Bashshur R.
        • Shannon G.
        • Krupinski E.
        • Grigsby J.
        The taxonomy of telemedicine.
        Telemed J E Health. 2011; 17: 484-494
        • American Telemedicine Association
        Telemedicine Glossary.
        (Available from:) (Accessed July 7, 2017)
        • Higgins J.P.T.
        • Sterne J.A.C.
        • Savović J.
        • Page M.J.
        • Hróbjartsson A.
        • Boutron I.
        • et al.
        A revised tool for assessing risk of bias in randomized trials.
        in: Chandler J. McKenzie J. Boutron I. Welch V. Cochrane Methods. Cochrane Database of Systematic Reviews. 2016 (Issue 10(Suppl 1))
        • Ryan R.
        • Hill S.
        How to GRADE the Quality of the Evidence.
        Cochrane Consumers and Communication Group, 2011 (Available from:) (Accessed December 15, 2017)
        • Higgins J.
        • Green S.
        Cochrane Handbook for Systematic Reviews of Interventions.
        2011 (Available from:) (Accessed July 15, 2017)
        • Begg C.B.
        • Mazumdar M.
        Operating characteristics of a rank correlation test for publication bias.
        Biometrics. 1994; 50: 1088-1101
        • Egger M.
        • Smith G.D.
        • Schneider M.
        • Minder C.
        Bias in meta-analysis detected by a simple, graphical test.
        Br Med J. 1997; 315: 629
        • Bender B.G.
        • Apter A.
        • Bogen D.K.
        • Dickinson P.
        • Fisher L.
        • Wamboldt F.S.
        • et al.
        Test of an interactive voice response intervention to improve adherence to controller medications in adults with asthma.
        J Am Board Fam Med. 2010; 23: 159-165
        • Clark N.M.
        • Gong Z.M.
        • Wang S.J.
        • Lin X.
        • Bria W.F.
        • Johnson T.R.
        A randomized trial of a self-regulation intervention for women with asthma.
        Chest. 2007; 132: 88-97
        • Kolmodin MacDonell K.
        • Naar S.
        • Gibson-Scipio W.
        • Lam P.
        • Secord E.
        The Detroit young adult asthma project: pilot of a technology-based medication adherence intervention for African-American emerging adults.
        J Adolesc Health. 2016; 59: 465-471
        • Vollmer W.M.
        • Kirshner M.
        • Peters D.
        • Drane A.
        • Stibolt T.
        • Hickey T.
        • et al.
        Use and impact of an automated telephone outreach system for asthma in a managed care setting.
        Am J Manag Care. 2006; 12: 725-733
        • Patel M.R.
        • Song P.X.
        • Sanders G.
        • Nelson B.
        • Kaltsas E.
        • Thomas L.J.
        • et al.
        A randomized clinical trial of a culturally responsive intervention for African American women with asthma.
        Ann Allergy Asthma Immunol. 2017; 118: 212-219
        • Pool A.C.
        • Kraschnewski J.L.
        • Poger J.M.
        • Smyth J.
        • Stuckey H.L.
        • Craig T.J.
        • et al.
        Impact of online patient reminders to improve asthma care: a randomized controlled trial.
        PLoS One. 2017; 12: e0170447
        • Barbanel D.
        • Eldridge S.
        • Griffiths C.
        Can a self-management programme delivered by a community pharmacist improve asthma control? A randomised trial.
        Thorax. 2003; 58: 851-854
        • Gruffydd-Jones K.
        • Hollinghurst S.
        • Ward S.
        • Taylor G.
        Targeted routine asthma care in general practice using telephone triage.
        Br J Gen Pract. 2005; 55: 918-923
        • Pinnock H.
        • Bawden R.
        • Proctor S.
        • Wolfe S.
        • Scullion J.
        • Price D.
        • et al.
        Accessibility, acceptability, and effectiveness in primary care of routine telephone review of asthma: pragmatic, randomised controlled trial.
        BMJ. 2003; 326: 477-479
        • Morrison D.
        • Wyke S.
        • Saunderson K.
        • McConnachie A.
        • Agur K.
        • Chaudhuri R.
        • et al.
        Findings from a pilot Randomised trial of an Asthma Internet Self-management Intervention (RAISIN).
        BMJ Open. 2016; 6: e009254
        • Newhouse N.
        • Martin A.
        • Jawad S.
        • Yu L.M.
        Randomised feasibility study of a novel experience-based internet intervention to support self-management in chronic asthma.
        BMJ. 2016; 6: e013401
        • Hashimoto S.
        • Ten Brinke A.
        • Roldaan A.C.
        • Van Veen I.H.
        • Möller G.M.
        • Sont J.K.
        • et al.
        Internet-based tapering of oral corticosteroids in severe asthma: a pragmatic randomised controlled trial.
        Thorax. 2011; 66: 514-520
        • Van Der Meer V.
        • Bakker M.J.
        • Van Den Hout W.B.
        • Rabe K.F.
        • Sterk P.J.
        • Kievit J.
        • et al.
        Internet-based self-management plus education compared with usual care in asthma: a randomized trial.
        Ann Int Med. 2009; 151: 110-120
        • Van Gaalen J.L.
        • Beerthuizen T.
        • Van Der Meer V.
        • Van Reisen P.
        • Redelijkheid G.W.
        • Snoeck-Stroband J.B.
        • et al.
        Long-term outcomes of internet-based self-management support in adults with asthma: randomized controlled trial.
        J Med Internet Res. 2013; 15: e188
        • Zairina E.
        • Abramson M.J.
        • McDonald C.F.
        • Li J.
        • Dharmasiri T.
        • Stewart K.
        • et al.
        Telehealth to improve asthma control in pregnancy: a randomized controlled trial.
        Respirology. 2016; 21: 867-874
        • Ahmed S.
        • Ernst P.
        The effectiveness of web-based asthma self-management system, My Asthma Portal (MAP): a pilot randomized controlled trial.
        J Med Internet Res. 2016; 18: e313
        • Strandbygaard U.
        • Thomsen S.F.
        • Backer V.
        A daily SMS reminder increases adherence to asthma treatment: a three-month follow-up study.
        Respir Med. 2010; 104: 166-171
        • Kim M.Y.
        • Lee S.Y.
        • Jo E.J.
        • Lee S.E.
        • Kang M.G.
        • Song W.J.
        • et al.
        Feasibility of a smartphone application based action plan and monitoring in asthma.
        Asia Pac Allergy. 2016; 6: 174-180
        • Liu W.T.
        • Huang C.D.
        • Wang C.H.
        • Lee K.Y.
        • Lin S.M.
        • Kuo H.P.
        A mobile telephone-based interactive self-care system improves asthma control.
        Eur Respir J. 2011; 37: 310-317
        • Lv Y.
        • Zhao H.
        • Liang Z.
        • Dong H.
        • Liu L.
        • Zhang D.
        • et al.
        A mobile phone short message service improves perceived control of asthma: a randomized controlled trial.
        Telemed J E Health. 2012; 18: 420-426
        • Cao Y.
        • Lin S.H.
        • Zhu D.
        • Xu F.
        • Chen Z.H.
        • Shen H.H.
        • et al.
        WeChat public account use improves clinical control of cough-variant asthma: A randomized controlled trial.
        Med Sci Monit. 2018; 24: 1524-1532
        • Cingi C.
        • Yorgancioglu A.
        • Cingi C.C.
        • Oguzulgen K.
        • Muluk N.B.
        • Ulusoy S.
        • et al.
        The "physician on call patient engagement trial" (POPET): measuring the impact of a mobile patient engagement application on health outcomes and quality of life in allergic rhinitis and asthma patients.
        Int Forum Allergy Rhinol. 2015; 5: 487-497
        • Pinnock H.
        • Adlem L.
        • Gaskin S.
        • Harris J.
        • Snellgrove C.
        • Sheikh A.
        Accessibility, clinical effectiveness, and practice costs of providing a telephone option for routine asthma reviews: phase IV controlled implementation study.
        Br J Gen Pract. 2007; 57: 714-722
        • Lee S.W.H.
        • Ooi L.
        • Lai Y.K.
        Telemedicine for the management of glycemic control and clinical outcomes of type 1 diabetes mellitus: a systematic review and meta-analysis of randomized controlled studies.
        Front Pharmacol. 2017; 8: 330
        • Ryan D.
        • Price D.
        • Musgrave S.D.
        • Malhotra S.
        • Lee A.J.
        • Ayansina D.
        • et al.
        Clinical and cost effectiveness of mobile phone supported self monitoring of asthma: multicentre randomised controlled trial.
        BMJ. 2012; 344: e1756
        • American Telemedicine Association
        Telemedicine Benefits.
        (Available from:) (Accessed May 15, 2018)
        • American Telemedicine Association
        Examples of Research Outcomes: Telemedicine’s Impact on Healthcare Cost and Quality.
        2013 (Available from:) (Accessed May 15, 2018)

      References

        • Gruffydd-Jones K.
        • Hollinghurst S.
        • Ward S.
        • Taylor G.
        Targeted routine asthma care in general practice using telephone triage.
        Br J Gen Pract. 2005; 55: 918-923
        • Vollmer W.M.
        • Kirshner M.
        • Peters D.
        • Drane A.
        • Stibolt T.
        • Hickey T.
        • et al.
        Use and impact of an automated telephone outreach system for asthma in a managed care setting.
        Am J Manag Care. 2006; 12: 725-733
        • Liu W.T.
        • Huang C.D.
        • Wang C.H.
        • Lee K.Y.
        • Lin S.M.
        • Kuo H.P.
        A mobile telephone-based interactive self-care system improves asthma control.
        Eur Respir J. 2011; 37: 310-317
        • Kim M.Y.
        • Lee S.Y.
        • Jo E.J.
        • Lee S.E.
        • Kang M.G.
        • Song W.J.
        • et al.
        Feasibility of a smartphone application based action plan and monitoring in asthma.
        Asia Pac Allergy. 2016; 6: 174-180
        • Zairina E.
        • Abramson M.J.
        • McDonald C.F.
        • Li J.
        • Dharmasiri T.
        • Stewart K.
        • et al.
        Telehealth to improve asthma control in pregnancy: a randomized controlled trial.
        Respirology. 2016; 21: 867-874
        • Pool A.C.
        • Kraschnewski J.L.
        • Poger J.M.
        • Smyth J.
        • Stuckey H.L.
        • Craig T.J.
        • et al.
        Impact of online patient reminders to improve asthma care: a randomized controlled trial.
        PLoS One. 2017; 12: e0170447
        • Pinnock H.
        • Bawden R.
        • Proctor S.
        • Wolfe S.
        • Scullion J.
        • Price D.
        • et al.
        Accessibility, acceptability, and effectiveness in primary care of routine telephone review of asthma: pragmatic, randomised controlled trial.
        BMJ. 2003; 326: 477-479
        • Morrison D.
        • Wyke S.
        • Saunderson K.
        • McConnachie A.
        • Agur K.
        • Chaudhuri R.
        • et al.
        Findings from a pilot Randomised trial of an Asthma Internet Self-management Intervention (RAISIN).
        BMJ Open. 2016; 6: e009254
        • Newhouse N.
        • Martin A.
        • Jawad S.
        • Yu L.M.
        Randomised feasibility study of a novel experience-based internet intervention to support self-management in chronic asthma.
        BMJ. 2016; 6: e013401
        • Barbanel D.
        • Eldridge S.
        • Griffiths C.
        Can a self-management programme delivered by a community pharmacist improve asthma control? A randomised trial.
        Thorax. 2003; 58: 851-854
        • Strandbygaard U.
        • Thomsen S.F.
        • Backer V.
        A daily SMS reminder increases adherence to asthma treatment: a three-month follow-up study.
        Respir Med. 2010; 104: 166-171
        • Van Der Meer V.
        • Bakker M.J.
        • Van Den Hout W.B.
        • Rabe K.F.
        • Sterk P.J.
        • Kievit J.
        • et al.
        Internet-based self-management plus education compared with usual care in asthma: a randomized trial.
        Ann Int Med. 2009; 151: 110-120
        • Cingi C.
        • Yorgancioglu A.
        • Cingi C.C.
        • Oguzulgen K.
        • Muluk N.B.
        • Ulusoy S.
        • et al.
        The "physician on call patient engagement trial" (POPET): measuring the impact of a mobile patient engagement application on health outcomes and quality of life in allergic rhinitis and asthma patients.
        Int Forum Allergy Rhinol. 2015; 5: 487-497
        • Kolmodin MacDonell K.
        • Naar S.
        • Gibson-Scipio W.
        • Lam P.
        • Secord E.
        The Detroit young adult asthma project: pilot of a technology-based medication adherence intervention for African-American emerging adults.
        J Adolesc Health. 2016; 59: 465-471
        • Clark N.M.
        • Gong Z.M.
        • Wang S.J.
        • Lin X.
        • Bria W.F.
        • Johnson T.R.
        A randomized trial of a self-regulation intervention for women with asthma.
        Chest. 2007; 132: 88-97
        • Lv Y.
        • Zhao H.
        • Liang Z.
        • Dong H.
        • Liu L.
        • Zhang D.
        • et al.
        A mobile phone short message service improves perceived control of asthma: a randomized controlled trial.
        Telemed J E Health. 2012; 18: 420-426
        • Bender B.G.
        • Apter A.
        • Bogen D.K.
        • Dickinson P.
        • Fisher L.
        • Wamboldt F.S.
        • et al.
        Test of an interactive voice response intervention to improve adherence to controller medications in adults with asthma.
        J Am Board Fam Med. 2010; 23: 159-165
        • Patel M.R.
        • Song P.X.
        • Sanders G.
        • Nelson B.
        • Kaltsas E.
        • Thomas L.J.
        • et al.
        A randomized clinical trial of a culturally responsive intervention for African American women with asthma.
        Ann Allergy Asthma Immunol. 2017; 118: 212-219
        • Cao Y.
        • Lin S.H.
        • Zhu D.
        • Xu F.
        • Chen Z.H.
        • Shen H.H.
        • et al.
        WeChat public account use improves clinical control of cough-variant asthma: a randomized controlled trial.
        Med Sci Monit. 2018; 24: 1524-1532
        • Hashimoto S.
        • Ten Brinke A.
        • Roldaan A.C.
        • Van Veen I.H.
        • Möller G.M.
        • Sont J.K.
        • et al.
        Internet-based tapering of oral corticosteroids in severe asthma: a pragmatic randomised controlled trial.
        Thorax. 2011; 66: 514-520
        • Van Gaalen J.L.
        • Beerthuizen T.
        • Van Der Meer V.
        • Van Reisen P.
        • Redelijkheid G.W.
        • Snoeck-Stroband J.B.
        • et al.
        Long-term outcomes of internet-based self-management support in adults with asthma: randomized controlled trial.
        J Med Internet Res. 2013; 15: e188
        • Ahmed S.
        • Ernst P.
        The effectiveness of web-based asthma self-management system, My Asthma Portal (MAP): a pilot randomized controlled trial.
        J Med Internet Res. 2016; 18: e313