The evidence base … the management of respiratory diseases
A recently published review of the role of technology in respiratory care examined the evidence base for the deployment of new technologies to improve care for people with asthma and COPD . The research revealed that a wide variety of assistive technologies are being used in asthma and COPD care – from self-monitoring devices to other support systems designed to enable individuals to manage these conditions. However, while patients were often ‘empowered’ by new technology, and staff generally ‘liked’ to utilise it after some training, the review found little objective evidence of benefits in terms of service, care and costs, either to patients or to the health care system.
In this sense, the study highlights a common problem about the evidence base for telehealth and telecare – studies are either poorly designed or lack the ability to make key judgements about impact on health gain or cost-effectiveness of care. As the authors of the article conclude, telecare and telehealth have ‘enormous potential’ to assist in the provision of better care for patients with asthma and COPD, but the evidence base is still weak. There is a need for more robust studies that provide answers to clear research questions before such technologies can be recommended for widespread implementation.
The WSDAN evidence database includes 15 other published studies on how patients with asthma and COPD are using assistive technologies. A rapid review of the methodologies employed shows that the vast majority are based either on interviews with staff and patients, and/or the examination of specific patient case histories over time. As a consequence, they have limited value.
However, there are some exceptions:
- A randomised controlled study in Hong Kong focused on the impact of follow-up telephone care on self-efficacy and use of health care among patients with COPD . It found a significant increase in self-efficacy in the experimental group, particularly among patients who had been high users of health services in the past.
- A study of 120 asthmatic children aged 6–17 in the United States found that access to online information and advice about using an inhaler significantly improved their technique and adherence when compared with traditional office-based care. Success was partly related to individuals keeping ‘diaries’ to record their symptoms and experiences . A study of 88 children in Taiwan who received a very similar intervention found that it helped to significantly improve asthma control, reduce symptoms, and improve reported quality of life .
- Mobile technologies – such as the use of SMS messaging to transfer data on self-reported symptoms (such as peak expiratory flow), with follow-up by a health professional if needed – have been shown to be cheap and potentially effective in improving management of conditions for patients with COPD and asthma . The Met Office’s ‘weather alert’ scheme has recently claimed that it has enabled significant reductions in hospital admissions.
These selected findings – like those we previously reviewed on the management of depression – suggest that proactive care management techniques targeted at the right patients can have a significant impact on their ability to self-manage their conditions. Clearly, what really counts is the care management of individuals – not the technologies per se – though, of course, these enable care providers to reach more people, more quickly and (potentially) more cost-effectively.
Nick Goodwin is co-project lead for WSDAN
 Smith S, Elkin S, Partridge M (2009). ‘Technology and its role in respiratory care’. Primary Care Respiratory Journal, vol 18, issue 3, pp 159–64.
 Wong KW, Wong FK, Chan MF (2005). ‘Effects of nurse-initiated telephone follow-up on self-efficacy among patients with chronic obstructive pulmonary disease’. Journal of Advanced Nursing, vol 49, issue 2, pp 210–22.
 Chan DS, Callahan CW, Hatch-Pigott VB, Lawless A, Proffitt HL, Manning NE, Schweikert M, Malone FJ (2007). ‘Internet-based home monitoring and education of children with asthma is comparable to ideal office-based care: results of a 1-year asthma in-home monitoring trial’. Pediatrics, vol 119, issue 3, pp 569–78.
 Jan RL, Wang JY, Huang MC, Tseng SM, Su HJ, Liu LF (2007). ‘An internet-based interactive telemonitoring system for improving childhood asthma outcomes in Taiwan’. Telemedicine Journal and e-Health, vol 13, issue 3, pp 257–68.
 Ostojic V, Cvoriscec B, Ostojic SB, Reznikoff D, Stipic-Markovic A, Tudjman Z (2005). ‘Improving asthma control through telemedicine: a study of short-message service’. Telemedicine Journal and e-Health, [JD3] [s4] vol 11, issue 1, pp 28–35.