Impacto de uma intervenção de telemedicina sobre o controle da asma grave: ensaio clínico randomizado

Abstract

This work aimed to evaluate the impact of a telemedicine intervention in the control of severe asthma in adults followed at a referral centre. This is a randomized clinical trial of a telemedicine intervention performed in adults with severe asthma. Participants were divided into Intervention Group (IG; n = 66) and Control Group (CG; n = 73) and evaluated at baseline (V0), 90 days (V90) and 180 days (V180) after the start of the intervention. The intervention consisted of weekly phone calls made by nurses between visits, in which the monitoring of symptoms and health education for asthma were addressed. The results of this work were: Article 1. Cost-effectiveness of telemedicine in the follow-up of asthmatics: systematic review – Systematic review in the PUBMED/MEDLINE, BIREME and Central Cochrane databases. Telemedicine costs were similar or slightly lower compared to usual treatments. Telemedicine interventions showed an effect on other asthma outcomes, such as disease control (1 of 5 studies), quality of life (3 of 5 studies), and hospitalizations (1 of 5 studies). Article 2. Telemedicine protocol for monitoring people with severe asthma in a developing country - a protocol was created with guiding questions that allow for clinical monitoring of asthma signs and symptoms, as well as health education for individuals. Article 3. Impact of a Telemedicine Intervention on the Control of Severe Asthma: Randomized Clinical Trial – a statistically significant difference in asthma control was observed after 180 days of intervention for the IG (p = 0.013) when compared to the values at the baseline, but it was not possible to confirm a significant improvement in asthma control in the IG compared to the CG, which was the primary outcome. Article 4. Telemedicine in Asthma Care: Reflections on the Covid-19 Pandemic – there was an increase in the use of telemedicine during the COVID-19 pandemic, demonstrating that these can be complementary strategies for prevention, monitoring and education in asthma aimed at minimizing geographic barriers, manage the disease and improve the quality of care, especially in unusual and challenging periods such as a pandemic. We conclude that for the sample studied, a six-month telemedicine intervention, based on weekly calls, guided by a specific protocol, had a statistically significant impact on the outcomes of correct use of inhaler devices, knowledge of asthma, and hospitalizations and emergency room visits. There was no impact on asthma control assessed by the ACQ6 (Asthma Control Questionnaire). Telemedicine interventions can be useful when combined with treatment and regular follow-up.