Asthma is a common condition affecting an estimated 300 million people worldwide and is increasing in prevalence in many countries [1]. Sub-optimal control of asthma is common, with patient adherence to regular preventer medication such as inhaled corticosteroids (ICS) reported to be as low as 30 % [1], potentially leading to increased symptoms, increased risk of asthma attacks and reduced quality of life [2, 3]. Patient education and proactive self-management have been shown to improve clinical outcomes in people with asthma [4, 5]. Guided self-management for asthma is aimed at improving knowledge of the condition and increasing the ability of an individual to manage variations in their asthma [6]. This offers the potential for an improved quality of life, as well as reductions in hospitalisations, emergency room visits, asthma attacks, unscheduled visits to the doctor, and days off work in those with asthma [7]. It is estimated that only a quarter of asthma patients have a self-management plan, despite evidence for the benefits of having one [8]. In most healthcare systems asthma is predominantly managed in primary care. However, primary care support for self-management in asthma can be sub-optimal [9].
One potential method for improving self-management is through the use of interactive digital interventions (IDIs), which offer the possibility of enabling patients to self-manage long-term conditions such as asthma and hence improve outcomes [10–12]. IDIs are packages that can combine health information with decision support to help inform behaviour change in patients, and are typically delivered through the internet or via smart phones. They offer the potential to improve the lives of people with asthma through automating and personalising routine aspects of education, monitoring and support, whilst at the same time giving patients convenient 24 h access to detailed, personalised feedback [13, 14]. There is evidence that well-designed IDIs can change patient health-related behaviour, improve patient knowledge and increase confidence for self-management of health problems [10, 11, 15].
There is little work assessing the impact of IDIs on asthma outcomes. Previous reviews of internet-based interventions have generally focused on telemedicine, where support may not necessarily be interactive or tailored to the user, finding that these interventions improved medication adherence [16] but did not improve asthma symptom scores [17]. Studies that have focused solely on self-management IDIs in those with asthma have included both children and adults and not restricted comparisons to usual care [18, 19]. Results of these reviews suggested that IDIs improved markers of self-care and knowledge, but evidence of improvement in clinical outcomes such as lung function were less clear [18, 19]. The successful implementation of IDIs into primary care will depend, at least in part, on their benefits and cost-effectiveness being clearly demonstrated to primary care clinicians [20, 21]. Therefore we undertook this systematic review to identify, summarise and synthesise the evidence for using IDIs to support patient self-management of asthma, and determine their impact on clinical outcomes, control and knowledge of asthma, quality of life, medication adherence, health service utilisation and cost-effectiveness.