Clinical trial NCT04166344: A MHealth Intervention to Improve Symptom Control in Children and Adolescents with Difficult-to-control Asthma
Official title: Effectiveness of a Web-based, Digital Health Platform Combining Social Care and Respiratory Coach Support to Improve Adherence to Treatment and Symptom Control in Children and Adolescents with Difficult-to-control Asthma
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Asthma in Children
Lead sponsor: Lovexair Foundation
Sponsor class: OTHER
Collaborators: name: Hospital Vall d'Hebron
name: Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau
name: Hospital Universitari Parc Salut Mar
name: Corporacion Parc Tauli
First posted: 2019-11-18
Enrollment: 60
Sex: ALL
Minimum age (years): 6
Maximum age (years): 18
Standard ages: CHILD
ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: SUPPORTIVE_CARE

Brief summary: Asthma is the most common chronic respiratory disease worldwide. Despite advances in asthma management, control of the disease is still a challenge especially among children. Information and communications technology (ICT) have been recently used in clinical practice to increase awareness of diseases, encourage patients to engage in the management of their conditions and improve monitoring and surveillance. The investigators of this study will test a new digital platform combining online/offline content aimed to improve asthma control and reduce exacerbations and unnecessary consultations in children with difficult-to-control asthma. A randomised controlled trial enrolling 60 patients allocated in two groups has been designed. The intervention group (IG) will be granted free access during 6 months to a web-based platform. During this period, patient will have access to online/off line content to improve disease awareness, monitor signs and symptoms and will also get the support of a respiratory coach. In addition, patients in this group will receive an electronic peak flow meter to register daily variations in maximal expiratory flow and an electronic device to connect to their inhaler to track adequate intake of inhaled medication. The control group (CG) will receive usual care consisted of scheduled visitations to medical doctors every 4 - 8 weeks. Both groups will be evaluated at baseline, post-intervention (6 months) and at follow up (one year) in the following variables: age, gender, asthma severity classification according to international guidelines, date of diagnosis, weight, height, Body Mass Index (BMI), forced expiratory volume in 1 second (FEV1), Asthma Control Test (ACT) score, treatment received for asthma, number of exacerbations in the previous 6 months and concomitant diseases. Exacerbations will be defined as any worsening in asthma symptoms that requires an increase in the usual therapy, an unscheduled physician visit, treatment in the emergency room or hospitalization.


Eligibility criteria: Inclusion Criteria:

* children between 6 and 18 years old;
* diagnosis of moderate to severe persistent asthma according to the international guidelines
* difficult to control asthma according to a scoring in the Asthma Control Questionnaire (ACQ) of 1.5 points or Asthma Control Test (ACT) ≤19;
* access to internet and a smartphone, tablet or computer;
* ability to understand and use the web-based platform (in children \<12 years the ability of the tutor or legal guardian);
* informed consent (by the tutor or legal guardian)

Exclusion Criteria:

* patients who have had an exacerbation in the previous two weeks;
* patients with intermittent asthma and/or well-controlled asthma according to the Asthma Control Questionnaire (ACQ) score of \<1.5 or Asthma Control Test (ACT) score ≥20;
* any neurological or psychiatric condition that prevents patients to use adequately the platform.

Primary outcomes:
measure: Differences in asthma control inter-group
timeFrame: 6 months
measure: Differences in asthma control inter-group
timeFrame: 12 months
Secondary outcomes:
measure: Inclusion rates (feasibility)
timeFrame: Baseline
measure: Completion rates
timeFrame: 12 months
measure: Incidence of exacerbations
timeFrame: 12 months
measure: Changes in lung function (FEV1)
timeFrame: 6 Months
measure: Changes in lung function (FEV1)
timeFrame: 12 Months
measure: Changes in lung function (PEF)
timeFrame: 6 Months
measure: Changes in lung function (PEF)
timeFrame: 12 Months
Other outcomes:
Locations:
city: Sabadell
country: Spain
facility: Hospital Universitari Parc Taulí
state: Barcelona
city: Barcelona
country: Spain
facility: Hospital del Mar
city: Barcelona
country: Spain
facility: Hospital Universitari Vall d'Hebron
city: Barcelona
country: Spain
facility: Hospital Santa Creu i Sant Pau
Study officials:
References:
citation: Carvajal-Uruena I, Garcia-Marcos L, Busquets-Monge R, Morales Suarez-Varela M, Garcia de Andoin N, Batlles-Garrido J, Blanco-Quiros A, Lopez-Silvarrey A, Garcia-Hernandez G, Guillen-Grimaj F, Gonzalez-Diaz C, Bellido-Blasco J. [Geographic variation in the prevalence of asthma symptoms in Spanish children and adolescents. International Study of Asthma and Allergies in Childhood (ISAAC) Phase 3, Spain]. Arch Bronconeumol. 2005 Dec;41(12):659-66. doi: 10.1016/s1579-2129(06)60333-9. Spanish.
citation: Sullivan PW, Ghushchyan V, Kavati A, Navaratnam P, Friedman HS, Ortiz B. Trends in Asthma Control, Treatment, Health Care Utilization, and Expenditures Among Children in the United States by Place of Residence: 2003-2014. J Allergy Clin Immunol Pract. 2019 Jul-Aug;7(6):1835-1842.e2. doi: 10.1016/j.jaip.2019.01.055. Epub 2019 Feb 15.
citation: Morita PP, Yeung MS, Ferrone M, Taite AK, Madeley C, Stevens Lavigne A, To T, Lougheed MD, Gupta S, Day AG, Cafazzo JA, Licskai C. A Patient-Centered Mobile Health System That Supports Asthma Self-Management (breathe): Design, Development, and Utilization. JMIR Mhealth Uhealth. 2019 Jan 28;7(1):e10956. doi: 10.2196/10956.
citation: Ahmed S, Ernst P, Bartlett SJ, Valois MF, Zaihra T, Pare G, Grad R, Eilayyan O, Perreault R, Tamblyn R. The Effectiveness of Web-Based Asthma Self-Management System, My Asthma Portal (MAP): A Pilot Randomized Controlled Trial. J Med Internet Res. 2016 Dec 1;18(12):e313. doi: 10.2196/jmir.5866.
citation: van Gaalen JL, Beerthuizen T, van der Meer V, van Reisen P, Redelijkheid GW, Snoeck-Stroband JB, Sont JK; SMASHING Study Group. Long-term outcomes of internet-based self-management support in adults with asthma: randomized controlled trial. J Med Internet Res. 2013 Sep 12;15(9):e188. doi: 10.2196/jmir.2640.
citation: Rasmussen LM, Phanareth K, Nolte H, Backer V. Internet-based monitoring of asthma: a long-term, randomized clinical study of 300 asthmatic subjects. J Allergy Clin Immunol. 2005 Jun;115(6):1137-42. doi: 10.1016/j.jaci.2005.03.030.
citation: Barrett MA, Humblet O, Marcus JE, Henderson K, Smith T, Eid N, Sublett JW, Renda A, Nesbitt L, Van Sickle D, Stempel D, Sublett JL. Effect of a mobile health, sensor-driven asthma management platform on asthma control. Ann Allergy Asthma Immunol. 2017 Nov;119(5):415-421.e1. doi: 10.1016/j.anai.2017.08.002.
citation: Newhouse N, Martin A, Jawad S, Yu LM, Davoudianfar M, Locock L, Ziebland S, Powell J. Randomised feasibility study of a novel experience-based internet intervention to support self-management in chronic asthma. BMJ Open. 2016 Dec 28;6(12):e013401. doi: 10.1136/bmjopen-2016-013401.
citation: Christakis DA, Garrison MM, Lozano P, Meischke H, Zhou C, Zimmerman FJ. Improving parental adherence with asthma treatment guidelines: a randomized controlled trial of an interactive website. Acad Pediatr. 2012 Jul-Aug;12(4):302-11. doi: 10.1016/j.acap.2012.03.006. Epub 2012 Jun 11.
citation: Reddel HK, Bateman ED, Becker A, Boulet LP, Cruz AA, Drazen JM, Haahtela T, Hurd SS, Inoue H, de Jongste JC, Lemanske RF Jr, Levy ML, O'Byrne PM, Paggiaro P, Pedersen SE, Pizzichini E, Soto-Quiroz M, Szefler SJ, Wong GW, FitzGerald JM. A summary of the new GINA strategy: a roadmap to asthma control. Eur Respir J. 2015 Sep;46(3):622-39. doi: 10.1183/13993003.00853-2015. Epub 2015 Jul 23.
citation: Sastre J, Olaguibel J, Vega JM, Del Pozo V, Picado C, Lopez Vina A. Cut-off points for defining asthma control in three versions of the Asthma Control Questionnaire. J Asthma. 2010 Oct;47(8):865-70. doi: 10.3109/02770903.2010.491149.
citation: Juniper EF, Gruffydd-Jones K, Ward S, Svensson K. Asthma Control Questionnaire in children: validation, measurement properties, interpretation. Eur Respir J. 2010 Dec;36(6):1410-6. doi: 10.1183/09031936.00117509. Epub 2010 Jun 7.
citation: Picado C, Badiola C, Perulero N, Sastre J, Olaguibel JM, Lopez Vina A, Vega JM; Covalair Investigator Group. Validation of the Spanish version of the Asthma Control Questionnaire. Clin Ther. 2008 Oct;30(10):1918-31. doi: 10.1016/j.clinthera.2008.10.005.