Impact of Telemedicine on Asthma Control and Quality of Life in Children and Adolescents: A Systematic Review and Meta-Analysis
Abstract
1. Introduction
2. Materials and Methods
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- Population (P): Children and adolescents (0–18 years) with a medical diagnosis of asthma, with no restrictions in terms of disease severity or gender.
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- Intervention (I): Interactive telemedicine interventions, including mobile applications (apps), videoconferencing, store and forward, remote monitoring or any combination of these tools. Interventions based exclusively on telephone communication were excluded.
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- Comparison (C): Usual care received by asthmatic patients according to standard clinical practice.
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- Outcomes (O): Changes in quality of life and asthma control attributable to the telehealth intervention, measured at defined time points.
- Do interactive telehealth interventions improve the quality of life of children and adolescents with asthma compared to usual clinical care?
- Do these interventions contribute to better disease control in children and adolescents with asthma compared to routine clinical care?
2.1. Literature Search Strategy
2.2. Literature Inclusion and Exclusion Criteria
2.3. Study Selection and Data Extraction
2.4. Information Synthesis
3. Results
3.1. General Characteristics of the Literature
Study | Country | Number of Patients (IV/CT) | Target Population | Description from Intervention and Control | Asthma Severity | Duration |
---|---|---|---|---|---|---|
Gümüs et al. (2024) [33] | Turkey | 97 (47/50) | 7–17 years with a diagnosis of asthma | IV: Education through Zoom and videos on the correct use of inhalers. Daily recording of symptoms and EF values. Continuous Zoom support. CT: Usual care. | No record | 6 months |
Suvarna et al. (2024) [40] | India | 192 (96/96) | 7–17 years with a diagnosis of asthma | IV: Mobile WhatsApp from the clinic. CT: In-person visit. | No record | 3 months |
Shdaifat et al. (2022) [41] | Jordan | 90 (45/45) | 5–11 years with asthma not controlled | IV: Video call education sessions with a pharmacist. CT: Usual care. | Moderate–Severe | 3 months |
Fedele et al. (2021) [39] | USA | 33 (17/16) | 12–15 years with asthma badly controlled | IV: App designed to improve asthma management and communication with caregivers by setting goals and identifying areas for improvement. CT: Autonomous control of asthma after receiving asthma information leaflets. | No record | 4 months |
Kosse et al. (2019) [34] | Netherlands | 234 (87/147) | 12–18 years with at least two prescriptions of ICS + LABA in the last 12 months | IV: App that includes a weekly disease control test, educational videos, medication reminder and chat with the pharmacist and other patients. CT: Inhalation instructions at first dispensation. | No record | 6 months |
Perry et al. (2018) [35] | USA | 363 (180/183) | 7–14 years old with asthma | IV: Asthma telematics education for the child, caregivers and school nurse. Follow-up of symptoms and lung function performed at school. CT: Usual care. | No record | 6 months |
Halterman et al. (2018) [38] | USA | 395 (199/199) | 3–10 years with a diagnosis of asthma | IV: Mobile telemedicine unit collecting information on patients’ symptoms and physical examination. A clinician undertakes the visit from their office and conducts a video call with the caregiver. CT: Usual care. | No record | 8 months |
Johnson et al. (2016) [43] | USA | 89 (46/43) | 12–17 years with prescribed medication for asthma control | IV: App for registration and SMS medication reminders. CT: Usual care. | No record | 3 weeks |
Voorend-van Bergen et al. (2015) [28] | Netherlands | 272 (183/89) | 4–18 years with atopic asthma | IV: Monthly monitoring through a website and treatment adjustment via e-mail. CT: Usual care. | No record | 12 months |
Rikkers- Mutsaerts et al. (2012) [30] | Netherlands | 90 (46/44) | 12–18 years with a diagnosis of asthma | IV: Online self-management system. Allows weekly recording of asthma control and lung function, and patient receives instant algorithm-based feedback. CT: Usual care. | Moderate–Severe | 12 months |
Deschildre et al. (2012) [31] | France | 50 (25/25) | 6–16 years with uncontrolled allergic asthma | IV: Daily home telemonitoring of spirometry with subsequent analysis by a physician, who adjusts treatment. CT: Usual care. | Severe | 12 months |
Eakin et al. (2012) [30] | USA | 322 (245/77) | 2–6 years with a diagnosis of asthma | IV: Mobile clinic that brings asthma screening, evaluation and treatment services to schools. Information is sent to the referring physician, who reviews treatment. CT: Usual care. | No record | 12 months |
Xu et al. (2010) [36] | Australia | 121 (80/39) | 3–16 years with asthma badly controlled | IV: Interactive voice response (IVR) system. Automated telephone calls that ask questions about symptoms and medication use and provide educational messages. CT: Usual care. | No record | 6 months |
Chan et al. (2007) [32] | USA | 120 (60/60) | 6–17 years with persistent asthma | IV: Virtual visits for education. Programmed dissemination of video recordings demonstrating inhaler use and peak flow measurement. Electronic diary for recording symptoms and communicating with the physician. CT: Regular care. | Mild–Severe | 12 months |
Jan et al. (2007) [42] | Taiwan | 164 (88/76) | 6–12 years with persistent asthma | IV: An interactive online system that provides educational information, an electronic diary, an action plan, and tools for analyzing symptoms and peak flow variability CT: Verbal information and educational brochure along with a symptom log diary. | Mild–Severe | 3 months |
Chan et al. (2003) [37] | USA | 10 (5/5) | 6–17 years with persistent asthma | IV: Video review system for inhaler use and symptom control, as well as education on inhaler techniques. CT: Non-synchronous access to healthcare professionals. | No record | 6 months |
3.2. Characteristics of Telemedicine Interventions
3.3. Effectiveness of Telemedicine Interventions
3.3.1. PAQLQ Quality-of-Life Results
3.3.2. Other Quality-of-Life Outcomes
3.3.3. ACT/c-ACT Asthma Control Outcomes
3.3.4. Other Asthma Control Outcomes
3.4. Subgroup Analysis and Sensitivity Analysis
4. Discussion
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Database | Search Terms | Articles Found |
---|---|---|
Pubmed | (“Telemedicine” [Mesh] OR “Remote Consultation” [Mesh] OR telemedicine [tiab] OR “telehealth” [tiab] OR “e-health” [tiab] OR “mobile health” [tiab] OR “mHealth” [tiab]) AND (“Pediatrics” [Mesh] OR “Child” [Mesh] OR “Infant” [Mesh] OR “Adolescent” [Mesh] OR pediatric * [tiab] OR child * [tiab] OR infant * [tiab] OR adolescent * [tiab]) AND (“Asthma” [Mesh] OR “Asthma Management” [tiab:~0] OR asthma [tiab] OR “asthma symptoms” [tiab] OR “asthma control” [tiab] OR “asthma exacerbations” [tiab])AND (“Quality of Life” [Mesh] OR “Patient Reported Outcome Measures” [Mesh] OR “Health Status” [Mesh] OR “QoL” [tiab] OR “quality of life” [tiab] OR “health-related quality of life” [tiab] OR HRQoL [tiab]) | 80 |
Cochrane | (telemedicine OR “remote consultation” OR telehealth OR “e-health” OR “mobile health” OR mHealth) AND (pediatric * OR child * OR infant * OR adolescent *) AND (asthma OR “asthma management” OR “asthma symptoms” OR “asthma control” OR “asthma exacerbations”) AND (“quality of life” OR “patient reported outcome measures” OR “health status” OR QoL OR HRQoL) | 64 |
Web of Science | TS = (“telemedicine” OR “remote consultation” OR “telehealth” OR “e-health” OR “mobile health” OR “mHealth”) AND TS = (“pediatric*” OR “child*” OR “infant*” OR “adolescent*”) AND TS = (“asthma” OR “asthma management” OR “asthma symptoms” OR “asthma control” OR “asthma exacerbations”) AND TS = (“quality of life” OR “patient reported outcome measures” OR “health status” OR “QoL” OR “HRQoL”) | 208 |
Study | Measurement Used | Results |
---|---|---|
Chan et al. (2003) [37] | PAQLQ and PACQLQ | Patients did not perceive changes in their quality of life during the study. However, the quality-of-life survey scores increased among caregivers in the intervention group. |
Jan et al. (2007) [41] | PAQLQ and PACQLQ | Both asthmatic children and their caregivers reported improvement in the quality of life after the trial, but only caregivers showed significant improvement. |
Eakin et al. (2012) [31] | PACQLQ | No statistically significant improvements were identified in any group or at any evaluation time in the quality of life of the caregivers. |
Johnson et al. (2016) [42] | Mini-PAQLQ | Quality of life increased from a mean of 5.7 to 6.3 in the intervention group compared to the control group (p = 0.037). |
Perry et al. (2018) [35] | PedsQL 3.0 and Mini-PAQL | The PedsQL 3.0 scores showed a trend toward improvement in participants in the intervention group compared to baseline. However, this improvement did not reach statistical significance. There was no change from baseline in the mini-PAQLQ scores for either group. |
Halterman et al. (2018) [38] | PACQLQ | Caregivers’ quality of life improved in both groups, but there were no significant differences. |
Shdaifat et al. (2022) [41] | Mini-PAQLQ | Patients in the intervention group showed greater improvements in both the overall and individual domains of the Mini-PAQLQ. |
Suvarna et al. (2024) [40] | Mini-PQLI (Pediatric Quality of Life Index) | There was a significant change in the mean scores for the Mini-PQLI in both the intervention and control groups. However, the mean difference in both groups was not significant. |
Gümüs et al. (2024) [33] | PAQLQ | The quality-of-life scores of the intervention and control groups were similar at the beginning of the study. However, at the end of the study, quality of life was higher in the intervention group. |
Study | Results |
---|---|
Chan et al. (2003) [37] | Patients achieved excellent control of their asthma during the study, with no emergency department visits, no hospitalizations and few unscheduled visits to the clinic for asthma. The excellent control was also reflected in the infrequent use of β-agonists. |
Jan et al. (2007) [42] | Children in the intervention group had a significant decrease in night-time (p 0.028) and daytime (p 0.009) symptoms compared to children in the control group. There were no significant differences between groups in the change in morning and night-time PEF from baseline. There were no differences between groups or within groups in the ACT score at the end of the study. |
Chan et al. (2007) [32] | Disease control was excellent in both groups. Emergency department visits and hospitalizations were infrequent. There were no differences in the use of rescue therapy between the groups or in forced vital capacity, forced expiratory volume in 1 s or forced expiratory flow in the mid-expiratory phase. |
Xu et al. (2010) [36] | There was no statistically significant difference between the intervention groups in the need for healthcare or oral corticosteroid rescue at the end of the study, nor a clear pattern of improved outcomes in any of the three groups. |
Eakin et al. (2012) [31] | An increase in symptom-free days was observed in the “Breathmobile” intervention group at 6 months compared to standard care. There was no significant reduction in hospitalizations or use of rescue medication in either group. |
Deschildre et al. (2012) [30] | The risk of exacerbation was inversely related to age. There were no significant differences between the two groups in the number of days of treatment with systemic corticosteroids, nor were there significant changes between the two groups in the mean dose of inhaled corticosteroids or in lung function. |
Rikkers-Mutsaerts et al. (2012) [29] | The results showed that self-management of asthma via the internet in adolescents with poorly controlled asthma led to a significant improvement in asthma control and lung function after 3 months compared to usual care. However, at 12 months, the beneficial effects were lost compared to the control group. |
Voorend-van Bergen et al. (2015) [28] | The change in the number of symptom-free days did not differ significantly between groups, nor did daily symptoms, exacerbations, lung function or β-2 agonist use. A significant decrease in the dose of inhaled corticosteroids was achieved in the web group. |
Halterman et al. (2018) [38] | Children in the intervention group had more symptom-free days after the intervention than children in the control group. They also had fewer daytime and night-time symptoms and fewer days with activity limitation. More children in the intervention group were prescribed preventive medication and had fewer emergency room visits than children in the control group, as well as a greater reduction in FeNO level. |
Perry et al. (2018) [35] | Symptom-free days in the previous 2 weeks improved for both groups, with no statistically significant differences between them. There were no significant differences in medication prescription. |
Kosse et al. (2019) [34] | The percentage of patients with adequate asthma control increased in both groups, with no significant difference between groups. |
Fedele et al. (2021) [39] | FEV1 values increased in both groups but the difference between groups was not statistically significant |
Shdaifat et al. (2022) [41] | All participants in the intervention group showed a significant decrease in healthcare resource utilization compared to those in the control group regarding the following parameters: number of hospitalizations, SABA refills, asthma exacerbations, SABA nebulizations/month, emergency room visits and use of corticosteroids. |
Suvarna et al. (2024) [40] | There were no significant differences in the number of exacerbations. |
Gümüs et al. (2024) [33] | Children in the virtual care group had fewer days with PEF levels below 80%. Children in the intervention group had lower PEF variability than children in the control group. Children in the intervention group also took less rescue medication and had more symptom-free days than children in the control group. Children in the control group had a higher number of unscheduled hospital visits. |
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Share and Cite
Gerriko, J.G.; Simoneau, T.; Gaffin, J.M.; Ortúzar Menéndez, M.; Fernandez-Montero, A.; Moreno-Galarraga, L. Impact of Telemedicine on Asthma Control and Quality of Life in Children and Adolescents: A Systematic Review and Meta-Analysis. Children 2025, 12, 849. https://doi.org/10.3390/children12070849
Gerriko JG, Simoneau T, Gaffin JM, Ortúzar Menéndez M, Fernandez-Montero A, Moreno-Galarraga L. Impact of Telemedicine on Asthma Control and Quality of Life in Children and Adolescents: A Systematic Review and Meta-Analysis. Children. 2025; 12(7):849. https://doi.org/10.3390/children12070849
Chicago/Turabian StyleGerriko, Julen Garcia, Tregony Simoneau, Jonathan M. Gaffin, Marina Ortúzar Menéndez, Alejandro Fernandez-Montero, and Laura Moreno-Galarraga. 2025. "Impact of Telemedicine on Asthma Control and Quality of Life in Children and Adolescents: A Systematic Review and Meta-Analysis" Children 12, no. 7: 849. https://doi.org/10.3390/children12070849
APA StyleGerriko, J. G., Simoneau, T., Gaffin, J. M., Ortúzar Menéndez, M., Fernandez-Montero, A., & Moreno-Galarraga, L. (2025). Impact of Telemedicine on Asthma Control and Quality of Life in Children and Adolescents: A Systematic Review and Meta-Analysis. Children, 12(7), 849. https://doi.org/10.3390/children12070849