***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To determine whether an asthma coaching program can improve  parent and child asthma-related quality of life ( QOL ) and reduce urgent care events . DESIGN R and omized controlled trial of usual care vs usual care with coaching . Comparisons were made between groups using mixed models . SETTING A Midwest city . PARTICIPANTS A community-based sample of 362 families with a child aged 5 to 12 years with persistent asthma . INTERVENTION A 12-month structured telephone coaching program in which trained coaches provided education and support to parents for 4 key asthma management behaviors . MAIN OUTCOME MEASURES Parental and child QOL measured with a vali date d , interview-administered , 7-point instrument and urgent care events in a year ( unscheduled office visits , after-hours calls , emergency department visits , or hospitalizations ) determined by record audit . RESULTS Parental asthma-related QOL scores improved by an average of 0.67 units ( 95 % confidence interval [ CI ] , 0.49 to 0.84 ) in the intervention group and 0.28 units ( 95 % CI , 0.10 to 0.46 ) in the control group . The difference between study groups was statistically significant ( difference , 0.38 ; 95 % CI , 0.14 to 0.63 ) . No between-group difference was found in the change in the child 's QOL ( difference , -0.17 ; 95 % CI , -0.47 to 0.12 ) or in the mean number of urgent care events per year ( difference , 1.15 ; 95 % CI , 0.82 to 1.61 ) . The proportion of children with very poorly controlled asthma in the intervention group decreased compared with the control group ( difference , 0.34 ; 95 % CI , 0.21 to 0.48 ) . CONCLUSIONS A telephone coaching program can improve parental QOL and can be implemented without additional physician training or practice re design 263 participants completing a r and omised controlled trial comparing  telephone vs. face-to-face asthma consultations were asked about preferences for future review s. Qualitative analysis of data from 209 respondents identified divergent views . Clear opinions were expressed about the respective roles of the two modes of consulting ; telephone consultations were considered convenient for review ing ' well controlled ' asthma , whereas face-to-face consultations were perceived as allowing in-depth assessment of problems in those with more symptomatic asthma . Practice s may consider offering patients the choice of a telephone or face-to-face review Background In patients with prednisone-dependent asthma the dose of oral corticosteroids should be adjusted to the lowest possible level to reduce long-term adverse effects . However , the optimal strategy for tapering oral corticosteroids is unknown . Objective To investigate whether an internet-based management tool including home monitoring of symptoms , lung function and fraction of exhaled nitric oxide ( FENO ) facilitates tapering of oral corticosteroids and leads to reduction of corticosteroid consumption without worsening asthma control or asthma-related quality of life . Methods In a 6-month pragmatic r and omised prospect i ve multicentre study , 95 adults with prednisone-dependent asthma from six pulmonary outpatient clinics were allocated to two tapering strategies : according to conventional treatment ( n=43 ) or guided by a novel internet-based monitoring system ( internet strategy ) ( n=52 ) . Primary outcomes were cumulative sparing of prednisone , asthma control and asthma-related quality of life . Secondary outcomes were forced expiratory volume in 1 s ( FEV1 ) , exacerbations , hospitalisations and patient 's satisfaction with the tapering strategy . Results Median cumulative sparing of prednisone was 205 ( 25–75th percentile −221 to 777 ) mg in the internet strategy group compared with 0 ( −497 to 282 ) mg in the conventional treatment group ( p=0.02 ) . Changes in prednisone dose ( mixed effect regression model ) from baseline were −4.79 mg/day and + 1.59 mg/day , respectively ( p<0.001 ) . Asthma control , asthma-related quality of life , FEV1 , exacerbations , hospitalisations and satisfaction with the strategy were not different between groups . Conclusions An internet-based management tool including home monitoring of symptoms , lung function and FENO in severe asthma is superior to conventional treatment in reducing total corticosteroid consumption without compromising asthma control or asthma-related quality of life . Clinical trial registration number Clinical trial registered with http://www.trialregister.nl ( Netherl and s Trial Register number 1146 ) Background : No r and omised studies have addressed whether self-management for asthma can be successfully delivered by community pharmacists . Most r and omised trials of asthma self-management have recruited participants from secondary care ; there is uncertainty regarding its effectiveness in primary care . A r and omised controlled study was undertaken to determine whether a community pharmacist could improve asthma control using self-management advice for individuals recruited during attendance at a community pharmacy . Methods : Twenty four adults attending a community pharmacy in Tower Hamlets , east London for routine asthma medication were r and omised into two groups : the intervention group received self-management advice from the pharmacist with weekly telephone follow up for 3 months and the control group received no input from the pharmacist . Participants self-completed the North of Engl and asthma symptom scale at baseline and 3 months later . Results : The groups were well matched at baseline for demographic characteristics and mean ( SD ) symptom scores ( 26.3 ( 4.8 ) and 27.8 ( 3.7 ) in the intervention and control groups , respectively ) . Symptom scores improved in the intervention group and marginally worsened in the control group to 20.3 ( 4.2 ) and 28.1 ( 3.5 ) , respectively ( p<0.001 ; difference adjusted for baseline scores = 7.0 ( 95 % CI 4.4 to 9.5 ) . Conclusions : A self-management programme delivered by a community pharmacist can improve asthma control in individuals recruited at a community pharmacy . Further studies should attempt to confirm these findings using larger sample s and a wider range of outcome measures Background Many children with asthma do not have sufficient asthma control , which leads to increased healthcare costs and productivity loss of parents . One of the causative factors are adherence problems . Effective interventions improving medication adherence may therefore improve asthma control and reduce costs . A promising solution is sending real time text-messages via the mobile phone network , when a medicine is about to be forgotten . As the effect of real time text-messages in children with asthma is unknown , the primary aim of this study is to determine the effect of a Real Time Medication Monitoring system ( RTMM ) with text-messages on adherence to inhaled corticosteroids ( ICS ) . The secondary objective is to study the effects of RTMM on asthma control , quality of life and cost-effectiveness of treatment . Methods A multicenter , r and omized controlled trial involving 220 children ( 4–11 years ) using ICS for asthma . All children receive an RTMM-device for one year , which registers time and date of ICS doses . Children in the intervention group also receive tailored text-messages , sent only when a dose is at risk of omission . Primary outcome measure is the proportion of ICS dosages taken within the individually predefined time-interval . Secondary outcome measures include asthma control ( monthly Asthma Control Tests ) , asthma exacerbations , healthcare use ( collected from hospital records , patient reports and pharmacy record data ) , and disease-specific quality of life ( PAQLQ question naire ) . Parental and children ’s acceptance of RTMM is evaluated with online focus groups and patient question naires . An economic evaluation is performed adopting a societal perspective , including relevant healthcare costs and parental productivity loss . Furthermore , a decision-analytic model is developed in which different levels of adherence are associated with clinical and financial outcomes . Also , sensitivity analyses are carried out on different price levels for RTMM . Discussion If RTMM with tailored text-message reminders proves to be effective , this technique can be used in daily practice , which would support children with suboptimal adherence in their asthma (self)management and in achieving better asthma control and better quality of life . Trial registration Netherl and s Trial Register NTR2583 Background Asthma is a chronic lung disease in which recurrent asthma symptoms create a substantial burden to individuals and their families . At the same time the economic burden associated with asthma is considerable . Methods The cost-effectiveness study was part of a single centre prospect i ve r and omised controlled trial comparing a nurse-led telemonitoring programme to usual care in a population of asthmatic out patients . The study included 109 asthmatic out patients ( 56 children ; 53 adults ) . The duration of follow-up was 12 months , and measurements were performed at baseline , 4 , 8 , and 12 months . Patients were asked to transfer their monitor data at least twice daily and by judging the received data and following a stepwise intervention protocol a nurse was able to act as the main caregiver in the intervention group . In both groups the EQ-5D and the SF-6D were used to obtain estimates of health state utilities . One year health care costs , patient and family costs , and productivity losses were calculated . The mean incremental costs were weighted against the mean incremental effect in terms of QALY . Results The study population generally represented mild to moderate asthmatics . No significant differences were found between the groups with regard to the generic quality of life . Overall , the mean health care costs per patient were higher in the intervention group than in the control group . The intervention costs mainly caused the cost difference between the groups . The intervention costs the society € 31,035/QALY gained with regard to adults and with regard to children € 59,071/QALY gained . Conclusion If the outcome is measured by generic quality of life the nurse-led telemonitoring programme is of limited cost-effectiveness in the study population . From the societal perspective the probability of the programme being cost-effective compared to regular care was 85 % at a ceiling ratio of € 80,000/QALY gained among the adults and 68 % among the children . A decrease in the price of the asthma monitor will substantial increase the probability of the programme to be cost-effective . Trial registration Number : Background Asthma is a prevalent and costly disease result ing in reduced quality of life for a large proportion of individuals . Effective patient self-management is critical for improving health outcomes . However , key aspects of self-management such as self-monitoring of behaviours and symptoms , coupled with regular feedback from the health care team , are rarely addressed or integrated into ongoing care . Health information technology ( HIT ) provides unique opportunities to facilitate this by providing a means for two way communication and exchange of information between the patient and care team , and access to their health information , presented in personalized ways that can alert them when there is a need for action . The objective of this study is to evaluate the acceptability and efficacy of using a web-based self-management system , My Asthma Portal ( MAP ) , linked to a case-management system on asthma control , and asthma health-related quality of life . Methods The trial is a parallel multi-centered 2-arm pilot r and omized controlled trial . Participants are r and omly assigned to one of two conditions : a ) MAP and usual care ; or b )  usual care alone .  Individuals will be included if they are between 18 and 70 , have a confirmed asthma diagnosis , and their asthma is classified as not well controlled by their physician .  Asthma control will be evaluated by calculating the amount of fast acting beta agonists recorded as dispensed in the provincial drug data base , and asthma quality of life using the Mini Asthma Related Quality of Life Question naire . Power calculations indicated a needed total sample size of 80 subjects . Data are collected at baseline , 3 , 6 , and 9 months post r and omization . Recruitment started in March 2010 and the inclusion of patients in the trial in June 2010 . Discussion Self-management support from the care team is critical for improving chronic disease outcomes . Given the high volume of patients and time constraints during clinical visits , primary care physicians have limited time to teach and reinforce use of proven self-management strategies . HIT has the potential to provide clinicians and a large number of patients with tools to support health behaviour change . Trial Registration Current Controlled Trials IS RCT N34326236 Background Internet-based self-management has shown to improve asthma control and asthma related quality of life , but the improvements were only marginally clinical ly relevant for the group as a whole . We hypothesized that self-management guided by weekly monitoring of asthma control tailors pharmacological therapy to individual needs and improves asthma control for patients with partly controlled or uncontrolled asthma . Methods In a 1-year r and omised controlled trial involving 200 adults ( 18 - 50 years ) with mild to moderate persistent asthma we evaluated the adherence with weekly monitoring and effect on asthma control and pharmacological treatment of a self-management algorithm based on the Asthma Control Question naire ( ACQ ) . Participants were assigned either to the Internet group ( n = 101 ) that monitored asthma control weekly with the ACQ on the Internet and adjusted treatment using a self-management algorithm supervised by an asthma nurse specialist or to the usual care group ( UC ) ( n = 99 ) . We analysed 3 subgroups : patients with well controlled ( ACQ ≤ 0.75 ) , partly controlled ( 0.75>ACQ ≤ 1.5 ) or uncontrolled ( ACQ>1.5 ) asthma at baseline .  Results Overall monitoring adherence was 67 % ( 95 % CI , 60 % to 74 % ) 
    Output:
    
Telemonitoring interventions may provide additional benefit for two measures of lung function .
AUTHORS ' CONCLUSIONS Current evidence does not support the widespread implementation of telemonitoring with healthcare provider feedback between asthma clinic visits .
Studies have not yet proven that additional telemonitoring strategies lead to better symptom control or reduced need for oral steroids over usual asthma care , nor have they ruled out unintended harms .