Vol. 18 •Issue 17 • Page 27
Virtual Asthma Clinic
Researchers Explore Web-Based Information Site
It was a Friday night and Brian was in the emergency room again, the fourth time for the year because he could not manage his asthma at home.
Thirteen-year-old Josh played outside all day while his mom was at work. At dinner, his mother noticed he kept coughing. She asked him whether he was OK, but like any other young man, he said he was fine.
The coughing continued, and Josh’s mom began to hear wheezing. She helped him take his inhaler, but she noticed little relief. Before bed, Josh’s mom decided it would be best to take him to the emergency room to be evaluated.
Trying to keep people healthy and at home is a constant balancing act for clinicians who care for asthma patients. Some asthmatics seem to be constantly in the emergency room with an exacerbation but refuse to follow up with their physician as they should. These are the people who typically lack the education they need to stay healthy.
To educate and manage the asthma of some of those “unreachable” patients, Canadian researchers have developed what they call a Virtual Asthma Clinic.
Barriers to Care
“One of the problems in Canada is geographic barriers. Many people don’t have access to large urban asthma education programs, and they can really benefit from an online program,” explained Irvin Mayers, MD, professor of Medicine at the University of Alberta in Edmonton.
“But even our urban patients often have barriers to accessing physicians, because there aren’t enough generalists,” he said. “This program allows them to be treated using the most up-to-date guidelines no matter where they live and to manage their asthma with minimal physician intervention. The program isn’t meant to replace doctors but to complement their ability to treat patients who are chronically ill.”
According to a study presented at the American Thoracic Society International Conference earlier this year, researchers said the availability of an online asthma management program could eventually help asthma patients get top-rate care and overcome barriers to health care access.
“We hope to develop an educational and disease-management plan that can improve access for patients with asthma to the best guideline-based treatment possible,” said Mayers. “This will overcome geographic and other barriers to care.”
Before and After
In the pilot study, researchers measured each patient’s lung function at the beginning of the study and after two months of using a secure Web site. During the two-month period, patients were encouraged to use the Web site to enter their peak flow rates and symptom information. Site users were able to ask asthma educators questions, get asthma information and fill out online questionnaires about their quality of life.
The 63 patients enrolled in the study used the Web site an average of 33 times during the study and entered their peak flow data a total of 27 times.
“Following guideline-based treatment can improve asthma control and thereby reduce dependence upon the ER for care,” said Mayers. “The Virtual Asthma Clinic also gives a patient a permanent accessible repository for their written action plan for the treatment of exacerbations. A written action plan, in turn, has been shown to reduce ER visits. Our underlying hypothesis is that better general control of asthma should result in less need for ER visits.”
Although researchers did not examine whether the site helped improve the asthma of their patients through the use of the online program, they are now setting up a randomized, controlled study that will look at whether the online program affects asthma attack frequency and utilization of health care.
“This approach is being investigated by us as well as others as a means of improving asthma,” said Mayers. “It is still in research phase. Like any treatment, it needs to be proven to have benefit. If proven to be successful, it will add a new piece to the clinical management of asthma.”
It is possible that in the future asthmatics might have a Virtual Asthma Clinic at their fingertips.
Marc Willis is a South Carolina television reporter.