Abstract
Background
Asthma is a chronic inflammatory disease of the airways. Proper use of inhaled medications and long-term standardized management are crucial for controlling asthma. In China, the morbidity of asthma among adults aged 20 and above is 4.2%, of which only 28.5% has been controlled.
Objective
This study aims to find the best model for long-term standardized asthma management by analyzing the effects of three follow-up methods: respiratory outpatient clinics follow-up, telephone follow-up, and WeChat follow-up on overall asthma control and patient medication compliance.
Methods
According to different follow-up methods, asthma patients were divided into a WeChat follow-up group (N = 140), a telephone follow-up group (N = 140), and an respiratory outpatient clinics follow-up group (N = 140), the three groups of patients underwent 12 months follow-up management. Outcomes were measured at baseline and after 1, 6, and 12 months of the intervention. The results of the assessment included the Medication Adherence Report Scale for Asthma (MARS-A), the Asthma Quality of Life Questionnaire (AQLQ), the Asthma Control Test Questionnaire (ACT), the satisfaction scale, the Beck Depression Inventory-II (BDI-II), the Global evaluation of treatment effectiveness (GETE), hospitalization, and emergency visits.
Results
Repeated measures analysis of variance showed that there were group effects and time effects on total MARS-A, ACT, BDI-II, GETE, and AQLQ in three groups (P < 0.001). Comparing the scores at the different times among the three groups, the results showed that the MARS-A, ACT, and AQLQ scores of the WeChat follow-up group were higher than those of the telephone follow-up group and the respiratory outpatient clinic follow-up group at 6 and 12 months after follow-up. In comparison, the BDI-II and GETE scores were lower than those of the telephone follow-up group and the respiratory outpatient clinic follow-up group (P < 0.05).
Conclusion
Our results demonstrate that all three follow-up methods improved asthma control, alleviate depression, and improve patient medication compliance, satisfaction, treatment effectiveness, and quality of life. However, the effect of the WeChat follow-up group is better than telephone follow-up and respiratory outpatient follow-up groups.
Clinical trial number
Not applicable.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12890-025-03771-1.
Keywords: Asthma, Adults, Follow-up management, Telemedicine, Quality of life, Medication compliance
Background
Asthma is a chronic inflammatory airway disorder characterized by persistent respiratory symptoms, impaired pulmonary function, and acute exacerbations requiring emergency medical intervention [1–3]. Epidemiological data indicate approximately 358 million asthma cases worldwide, of which only 28.5% have achieved optimal disease control [4, 5]. Substantial evidence demonstrates that uncontrolled asthma correlates significantly with inadequate patient education, deficient self-management competencies, and improper inhalation techniques, underscoring the critical need for enhanced long-term follow-up strategies [6].
The Global Initiative for Asthma(GINA) emphasize the pivotal role of regular follow-up in disease management [7].While conventional clinic-based follow-ups provide comprehensive clinical evaluations, they are hampered by a 35% attrition rate. Telephone follow-ups, despite improving accessibility, yield only 62.3% patient satisfaction rates. Emerging mobile health technologies present novel solutions, with clinical trials demonstrating that app-based interventions can enhance asthma control rates by 40% [8–13]. WeChat is the main social media platform for Chinese people, accounting for 86% of the users. It shows a special prospect in chronic disease management, and has improved the drug compliance of chronic disease patients by 2.1 times [14]. Nevertheless, robust comparative evidence evaluating different asthma follow-up modalities remains scarce.
This 12-month prospective cohort study systematically compared three follow-up methods (telephone, WeChat, and respiratory outpatient clinic follow-up) to evaluate their impact on asthma control, medication adherence, quality of life, and patient satisfaction. The research findings aim to establish long-term asthma management and guide clinical decision-making.
Methods
Study design
This prospective cohort study compared the effects of three follow-up management methods (WeChat, telephone, and respiratory outpatient clinic follow-up) on asthma control over a 12-month period. Participants were recruited at the Respiratory Outpatient Department of the Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China from July 2022 to October 2022. Participants were non-randomly assigned to follow-up groups based on their communication preferences and practical accessibility: the WeChat follow up group (N = 140) comprised patients comfortable with digital health platforms; telephone follow up group (N = 140) included those preferring traditional voice communication; and respiratory outpatient follow-up group (N = 140) consisted of patients favoring face-to-face consultations. All study participants volunteered to participate and signed a written informed consent form. Participants could withdraw from the study at any time without penalty. Allocations were concealed using sequentially numbered opaque sealed envelopes.
Participants
Eligibility criteria
This study recruited asthmatics aged between 18 and 70 years, with a disease duration of ≥ 3 months and meeting the diagnostic criteria of GINA 2023 [7]. ACT score of ≤ 19 (uncontrolled asthma) or 20–24 (partially controlled asthma); (2) Screening by the Medication Adherence Report Scale for the Assessment of Asthmatic Diseases, scored < 45 points; (3) Patients using Inhaled Corticosteroid(ICS) combined Long-acting Beta-agonist(LABA)for at least 3 months; (4) Able to read, understand the contents of the questionnaire and complete the survey on their own or with the assistance of medical workers; (5) Able to sign an informed consent and complete follow-up visits voluntarily.
Exclusion criteria
(1) Exclude patients with other chronic respiratory diseases (e.g. chronic obstructive pulmonary disease, respiratory expansion, lung cancer, pneumonia, etc.); (2) Patients with severe heart, liver, kidney, and nervous and psychiatric disorders (such as dementia, Parkinsonism, and intellectual impairment); (3) Patients without or unable to operate mobile phones; (4) Patients with prolonged hospitalizations (more than 2 weeks each), multiple hospitalizations (treatment more than 3 times a year) due to other underlying diseases; (5) Hearing and visual impairments.
Establishment of an asthma follow-up management team
The research team consists of 9 members, including 3 doctors, 3 nurses, 1 pharmacist, and 2 postgraduates, all of whom receive unified asthma management training. (1) The recruitment team consists of 1 doctor, 2 postgraduates, and 1 nurse. (2) Follow-up: Composed of 2 doctors, 2 nurses, 1 pharmacist, and 2 postgraduates, they are responsible for regular follow-up management and health education; (3) Data collection and analysis: Nurses and postgraduates are responsible for collecting and analyzing follow-up data and related questionnaires.
Follow-up management
After recruitment, three groups of patients received medication guidance, inhalation device usage, and asthma self-management. The content of the asthma self-management includes the goals and significance of asthma self-management, common causes of asthma, tools for asthma self-management, initial management of acute asthma attacks, self-management of severe asthma, prevention of asthma, and answers to other common questions.
WeChat follow-up group: researchers establish a WeChat follow-up group and WeChat official account, guide patients to join the WeChat group, and help patients use mobile phones to subscribe to follow the WeChat official account and WeChat group. Researchers push asthma health education once every 2 weeks, lasting 15–20 min each time, until the end of the follow-up (including introduction, diagnosis, examination, medication, emergency response, dietary guidance, vaccination, pulmonary rehabilitation, etc.); Push a personal medication list in the WeChat group, including asthma medication dosage and precautions, a medication guidance list with medication inhalation device operation video QR code, and various inhalation device teaching videos; Various forms of online consultation, health education, and medication guidance are provided for asthma patients through the WeChat communication group, the WeChat official account, live conferences, and other forms. Patients communicate with medical staff online through the WeChat group to communicate their asthma conditions, obtain professional guidance.
Telephone follow-up group: Researchers conducted telephone follow-up on asthma patients every 2 weeks until the end of the follow-up. Conduct 15–20 min asthma health education to patients via phone, including introduction, diagnosis, examination, medication, emergency treatment, dietary guidance, vaccination, dosage and precautions of asthma drugs, pulmonary rehabilitation, etc. Provide professional guidance on asthma knowledge and conduct questionnaire surveys over the phone.
Respiratory Outpatient follow-up group: Asthma patients undergo every 2 weeks outpatient follow-up, where outpatient doctors and clinical pharmacists provide 15–20 min medication guidance, outpatient nurses provide health education and questionnaire surveys to asthma patients, evaluate asthma symptom control, and nurses provide face-to-face guidance on inhalation medication use, distribute medication usage lists, provide dietary education and pulmonary rehabilitation guidance, and guide patients to regular outpatient visits.
Data collection: During the patient follow-up process, the researchers collected data four times. At baseline, 1, 6 and 12 months of treatment, patients were assessed using the following instruments: the Asthma Control Test (ACT), the Asthma Quality of Life Questionnaire (AQLQ), the Beck Depression Inventory-II (BDI-II), the Global Evaluation of Treatment Effectiveness (GETE), and the Medication Adherence Report Scale for Asthma (MARS-A). Collect the number of hospitalizations, emergency visits, and satisfaction scores of three groups of patients after follow-up.
Outcome measures
TheACT is a questionnaire for assessing asthma-control levels, with a total score of 25 divided into complete control levels, 20 to 24 in partially controlled levels, and < 19 in uncontrolled levels [15].
TheMARS-A is a simple questionnaire used to measure medication adherence in asthma patients. The total score on the scale is 0 to 50 points, and the higher the total score, the better the medication adherence of the patient. Among them, a score of 45 or above indicates good compliance [16].
TheAQLQ is used to evaluate the quality of life of people with asthma, which assesses the overall health of patients from the three aspects of physical, psychological, and social adaptation of asthma patients, in a total of 35 entries, including activity limitation, asthma symptoms, mental conditions, responses to stimuli and concern for their health. The questionnaire uses a 7-dimensional score with a total score of 245, the higher the score, the lighter the degree of impact [17].
TheBDI-II is a scale used to assess depression related symptoms over the past 4 weeks, consisting of 21 items. These projects are rated on a 4-point scale (0 to 3), with a total score of 63 points. The higher the score, the more severe the depressive symptoms [18, 19].
Using the satisfaction scale developed by Yang et al., evaluate the satisfaction of patients, The total score of the scale was 100 points, 80 to 100 points were very satisfied, 60 to 79 points were satisfied, and 59 points and below were dissatisfied [20].
GETE is to evaluate the overall efficacy of asthma symptom control and asthma treatment. According to a 5-point scale, 1 is excellent (asthma fully controlled), and 5 is worst (worsening) [21].
Data analysis
Data analysis was conducted using SPSS 22.0 software. In this study, the continuous variables all exhibited normality and homogeneity of variance, data are presented as the mean and standard deviation (SD) for continuous variables, categorical variables are described using frequency and percentage, and the chi-square test is used. The comparison between groups was conducted using a one-way ANOVA. In order to evaluate the impact of intervention measures on the results, we used repeated measures ANOVA to compare the scores of the scales at each time point. When there were significant differences in the interaction effects, we further used simple effects analysis to evaluate the interaction effects between time, between groups, between groups, and time. The intention to treat (ITT) principle was used to organize the outcome indicator data of patients, and the outcome indicators of lost to follow-up patients were supplemented with missing data values or data from the last observation record as the results for analysis. GraphPad Prism 5 software was used for plotting, P value < 0.05 was considered to indicate statistical significance.
Results
In the study, a total of 428 subjects were evaluated as qualified, with 8 excluded, of whom 4 were over age, 3 were unable to use mobile devices and 1 refused to participate in the study. The average randomization of 420 participants was made into WeChat follow-up groups (N = 140), Telephone follow-ups (N = 140), and respiratory outpatient clinics follow-ups (N = 140). During the follow-up intervention period, 38 participants were lost to follow-up, including 4 in the WeChat follow-up group, 16 in the telephone follow-up group, and 18 in the respiratory outpatient follow-up group. The reasons included: lack of time for attendance, other health treatments not related to this study, difficulty in accessing hospitals, addresses or job changes, difficulties in absence due to treatment, and other reasons (Fig. 1).
Fig. 1.
Enrollment (CONSORT diagram, 2010).TT = Intention to treat
There was no significant difference in baseline demographic characteristics among the three groups (Table 1; all P > 0.05). There was no statistically significant difference in baseline data of MARS-A, AQLQ, BIDII, ACT, and GETE among the three groups of patients before follow-up (Table 2). The WeChat follow-up group provided significant benefits in comparison with the telephone and respiratory outpatient clinics follow-up group, with MARS-A scores significantly improved in 1 month (P< 0.001) for three groups, decreasing in the 6 months (P = 0.006) and then stabilized (P = 0.041), and intergroup comparisons showed statistically significant differences in the 1, 6, and 12 months (P < 0.05), with WeChat patients showing significant improvement in 12 months compared to the other two groups (Fig. 2).
Table 1.
Participant characteristics at baseline (N = 420)
| Parameters | Telephone (n = 140) | WeChat (n = 140) |
Respiratory outpatient clinics (n = 140) | Statistical indices | P-value |
|---|---|---|---|---|---|
| Gender, Number (%) | |||||
| Male | 68(48.57) | 69(49.29) | 71(50.71) | 0.133a | 0.936 |
| Female | 72(51.43) | 71(50.71) | 69(49.29) | ||
| Age, Number (%) | |||||
| 18–39 | 44(31.43) | 42(30.00) | 40(28.57) | 0.934a | 0.920 |
| 40–60 | 66(47.14) | 72(51.43) | 69(49.29) | ||
| >60 | 30(21.43) | 26(18.57) | 31(22.14) | ||
| Education, Number (%) | |||||
| Undergraduate or below | 88(62.86) | 97(69.29) | 88(62.86) | 4.135a | 0.388 |
| undergraduate | 52(37.14) | 41(29.29) | 51(36.43) | ||
| master’s degree or above | 0(0.00) | 2(1.42) | 1(0.71) | ||
| Residence, Number (%) | |||||
| rural | 55(39.29) | 51(36.43) | 48(34.29) | 0.759a | 0.684 |
| urban | 85(60.71) | 89(63.57) | 92(65.71) | ||
| smoke, Number (%) | |||||
| yes | 5(3.57) | 3(2.14) | 7(5.00) | 1.659a | 0.436 |
| no | 135(96.43) | 137(97.86) | 133(95.00) | ||
| tipple, Number (%) | |||||
| yes | 2(1.43) | 1(0.71) | 1(0.71) | 0.505a | 0.777 |
| no | 138(98.57) | 139(99.29) | 139(99.29) | ||
| BMI, kg/m2,mean (SD) | 23.55 ± 2.405 | 24.03 ± 5.692 | 23.16 ± 2.032 | 0.517b | 0.597 |
| Treatment(%) | |||||
| Salmeterol/Fluticasone | 8(5.71) | 5(3.57) | 7(5.00) | 0.735a | 0.692 |
| Formoterol/Budesonide | 132(94.29) | 135(96.43) | 133(95.00) | ||
| Comorbidities | |||||
| Heart disease | 2(1.43) | 3(3.57) | 2(14.29) | 0.929a | 0.998 |
| Diabetes | 1(0.71) | 1(0.71) | 2(14.29) | ||
| Hypertension | 3(2.14) | 6(4.29) | 4(2.86) | ||
| Others | 1(0.71) | 2(1.43) | 1(0.71) |
BMI, body mass index; kg, kilograms; a, Chisquared test; b,one-way ANOVA
Table 2.
Comparison of the outcome variables among three groups
| Variables | Group | samples | Baseline | 1month | 6 months | 12 month s | F1(p) | F2(p) | F3(p) |
|---|---|---|---|---|---|---|---|---|---|
| MARS-A | 140 | 29.31 ± 2.79 | 46.30 ± 4.45 | 44.27 ± 5.55 | 42.13 ± 3.67 |
665.01 (<0.001) |
10.35 (<0.001) |
89.087 (<0.001) |
|
| Telephone | 140 | 29.33 ± 2.67 | 39.31 ± 5.29 | 34.31 ± 5.03 | 33.31 ± 3.79 | ||||
| Respiratory outpatient clinics | 140 | 29.39 ± 2.63 | 41.25 ± 5.32 | 40.39 ± 4.37 | 39.46 ± 3.61 | ||||
| F | 1.848 | 11.447 | 5.218 | 3.920 | |||||
| P | 0.159 | <0.001 | 0.006 | 0.041 | |||||
| AQLQ | 140 | 153.47 ± 27.32 | 162.58 ± 27.06 | 177.51 ± 26.53 | 196.25 ± 27.28 |
681.734 (<0.001) |
3.800 (0.023) |
276.490 (<0.001) |
|
| Telephone | 140 | 153.54 ± 28.28 | 157.54 ± 28.06 | 167.40 ± 28.23 | 165.98 ± 27.88 | ||||
| Respiratory outpatient clinics | 140 | 159.38 ± 27.14 | 165.90 ± 25.21 | 175.76 ± 24.80 | 182.90 ± 24.71 | ||||
| F | 0.007 | 1.293 | 17.260 | 63.446 | |||||
| P | 0.993 | 0.276 | <0.001 | <0.001 | |||||
| BDI-II | 140 | 14.35 ± 2.12 | 11.45 ± 2.48 | 9.50 ± 2.51 | 8.57 ± 2.01 |
179.456 (<0.001) |
45.321 (<0.001) |
89.451 (<0.001) |
|
| Telephone | 140 | 13.98 ± 2.08 | 12.23 ± 2.62 | 12.35 ± 2.37 | 12.09 ± 3.02 | ||||
| Respiratory outpatient clinics | 140 | 14.01 ± 2.41 | 12.71 ± 2.05 | 11.56 ± 2.33 | 11.81 ± 3.56 | ||||
| F | 0.178 | 1.753 | 3.483 | 4.821 | |||||
| P | 0.867 | 0.207 | 0.045 | 0.003 | |||||
| ACT | 140 | 14.56 ± 3.04 | 21.28 ± 1.97 | 23.67 ± 2.36 | 24.57 ± 0.67 |
90.581 (<0.001) |
19.561 (<0.001) |
41.341 (<0.001) |
|
| Telephone | 140 | 13.41 ± 2.98 | 16.36 ± 3.10 | 16.21 ± 0.45 | 16.01 ± 2.43 | ||||
| Respiratory outpatient clinics | 140 | 13.56 ± 2.95 | 17.08 ± 3.30 | 18.34 ± 2.21 | 20.03 ± 0.56 | ||||
| F | 1.152 | 27.15 | 55.761 | 57.321 | |||||
| p | 0.764 | <0.001 | <0.001 | <0.001 | |||||
| GETE | 140 | 4.67 ± 0.45 | 3.05 ± 0.13 | 2.03 ± 0.41 | 1.34 ± 0.45 |
89.341 (<0.001) |
7.621 (0.002) |
45.211 (<0.001) |
|
| Telephone | 140 | 4.35 ± 0.23 | 4.18 ± 0.24 | 3.43 ± 1.02 | 3.37 ± 0.37 | ||||
| Respiratory outpatient clinics | 140 | 4.56 ± 0.14 | 3.95 ± 0.45 | 3.04 ± 0.67 | 2.58 ± 1.03 | ||||
| F | 1.561 | 22.012 | 31.891 | 40.451 | |||||
| p | 0.361 | <0.001 | <0.001 | <0.001 |
F1, Group effect; F2, Time effect; F3, Interaction effect
Fig. 2.
MARS-A scores among three groups of patients. *Inter-group F test, P < 0.05. NS, Not significant
The AQLQ scores of the three groups of patients slightly increased in the 1 month, but there was no statistically significant difference between the three groups (P = 0.276). At the 6 months of follow-up, the AQLQ scores of the three groups of patients significantly increased (P < 0.001). Compared with baseline data, the AQLQ improvement effect of the WeChat follow-up group was more significant in the 12 months (Fig. 3).
Fig. 3.
AQLQ scores among three groups of patients. *Inter-group F test, P < 0.05. NS, Not significant
The BDI-II scores of the three groups of patients slightly decreased in the 1 month of follow-up, with no significant difference (P>0.05). They decreased at the 6 months of follow-up, and the BDI-II scores of the three groups gradually decreased (P = 0.045). Compared with baseline data, the improvement effect of BDI-II in the WeChat follow-up group was more significant at the 12 months of follow-up (P = 0.003) (Fig. 4).
Fig. 4.
BDI-II scores among three groups of patients. *Inter-group F test, P < 0.05. NS, Not significant
The ACT scores of the three groups of patients improved at different times (P < 0.05), and the ACT scores of the WeChat follow-up group and the respiratory outpatient clinics follow-up group increased gradually at different points, while the telephone follow-up group improved most significantly in the 1 month of follow-up and then stabilized. Compared to the baseline, the WeChat follow-up group improved more significantly 12 months (Fig. 5).
Fig. 5.
ACT scores among three groups of patients. *Inter-group F test, P < 0.05. NS, Not significant
The GETE scores of the three groups of patients tended to decline at different follow-up times, with statistically significant differences (P < 0.001) compared to the baseline data for the 12 months of follow-up (Fig. 6).
Fig. 6.
GETE scores among three groups of patients. *Inter-group F test, P < 0.05. NS, Not significant
The results of repeated measures ANOVA show that from base to 12 months of follow-up, the effects of MARS-A scores (F = 665.01, P < 0.001), AQLQ (F = 681.734, P < 0,001), BIDII (F = 179.456, P < 0.001), ACT (F = 90.581, P < 0.001) and GETE (F = 89.341 and P < 0,001) were both significant (P < 0.05), indicating the effectiveness of the three follow-up intervention schemes, with differences between the scores of each time point, indicating that over time the study results were affected by time. Meanwhile, the score interactions of MARS-A scores (F = 89.087, P < 0.001), AQLQ (F = 276.490, P < 0.001) and BDI-II (F = 89.451, P < 0.001), ACT (F = 41.341, P < 0.001) as well as GETE (F = 45.211, P < 0,001) were significant, indicating that the results were influenced by time and intervention interactions (Table 2).
At the end of the follow-up, the satisfaction rate of the WeChat follow-up group was 97.27%, the satisfaction rate of the telephone follow-up group was 91.94%, and the satisfaction rate of the respiratory outpatient clinics follow-up group was 90.98% (Fig. 7), the difference was statistically significant (P < 0.05) (Table 3). The hospitalization and emergency visits of the three groups of patients have decreased compared to baseline data. There was statistically significant difference in hospitalization and emergency visits among the three groups of patients (P < 0.05) (Table 4).
Fig. 7.
The proportion of satisfaction among patients in different follow-up groups. At the end of the follow-up, the satisfaction rate of patients with WeChat follow-up was 97.27%, the satisfaction rate with the telephone follow-up group was 91.94%, and the satisfaction rate with outpatient respiratory clinics follow-up was 90.98%
Table 3.
Patient satisfaction at the end of follow-up among three groups
| Characteristics | samples | Very satisfaction | Satisfaction | Unsatisfaction | Overall satisfaction |
P-value |
|---|---|---|---|---|---|---|
| WeChat, Number (%) | 136 | 128(94.12) | 7(5.15) | 1(0.73) | 135(97.27) | 0.018 |
| Telephone, Number (%) | 124 | 110(88.71) | 4(3.23) | 10(8.06) | 114(91.94) | |
| Respiratory outpatient clinicss, Number (%) | 122 | 109(89.34) | 2(1.64) | 11 (9.02) | 111(90.98) |
Table 4.
Hospitalization and emergency visits baseline and at the end of follow-up among three groups
| Characteristics | samples | Baseline (times) |
P-value | samples | The end of follow-up (times) |
P-value | ||||
|---|---|---|---|---|---|---|---|---|---|---|
| 0 | 1 | ≥ 2 | 0 | 1 | ≥ 2 | |||||
|
Hospitalizations ,Number (%) |
||||||||||
| 140 | 75(53.57) | 35(25.00) | 30(21.43) | 0.839 | 136 | 120(88.24) | 10(7.35) | 6(4.41) | 0.006 | |
| Telephone | 140 | 77(55.50) | 28(20.00) | 35(24.5) | 124 | 103(83.06) | 4(3.23) | 17(13.71) | ||
| Respiratory outpatient clinics | 140 | 79(56.43) | 29(20.71) | 32(22.86) | 122 | 105(86.07) | 1(0.82) | 16(13.11) | ||
|
Emergency Visits, Number (%) |
||||||||||
| 140 | 73(52.14) | 35(25.00) | 32(22.86) | 0.728 | 136 | 124(91.18) | 7(5.15) | 5(3.67) | 0.018 | |
| Telephone | 140 | 76(54.29) | 27(19.29) | 37(26.42) | 124 | 104(83.87) | 2(1.61) | 18(14.52) | ||
| Respiratory outpatient clinics | 140 | 78(55.71) | 30(21.43) | 32(22.86) | 122 | 104(85.25) | 3(2.45) | 15(12.30) | ||
There was no statistically significant difference in asthma control among the three groups of patients at baseline (P > 0.05). At the end of the study, the proportion of patients with ACT ≥ 20 and no acute exacerbation in the WeChat group was significantly higher than that in the telephone group and outpatient group (P < 0.05) (Table 5).
Table 5.
The proportion of patients with controlled ACT and no hospitalization or emergency among the three groups of patients at baseline and the end of follow-up
| Characteristics | samples | Baseline Asthma control, Number (%) |
P-value | The end of follow-up Asthma control, Number (%) |
P-value |
|---|---|---|---|---|---|
| 140 | 75(53.57) | 0.891 | 124(88.57) | 0.007 | |
| Telephone | 140 | 77(55.00) | 104(74.29) | ||
| Respiratory outpatient clinics | 140 | 79(56.43) | 108(77.14) |
Discussion
Asthma is a heterogeneous chronic airway disease that requires personalized assessment and management. Long term standardized management is crucial for asthma patients [22]. However, in respiratory outpatient clinics, face-to-face medication guidance in asthma education rooms is often limited by a shortage of medical staff, and patient follow-up is often affected by factors such as weather, traffic, economic conditions, and emotional states, leading to poor compliance. Therefore, exploring more effective follow-up management models is crucial. Research has shown that continuous follow-up management based on telemedicine can enhance patients’ disease awareness and self-management skills, improve doctor-patient communication, and provide personalized professional support to help control symptoms [23, 24].
Telemedicine is a way of using communication technology to achieve remote clinical diagnosis, health education, public health, and health management [25], It mainly includes text messages, phone calls, applications, social platforms, wearable devices, virtual reality, and a combination of various methods, which have achieved significant results in the management of respiratory chronic diseases [26–28].The WeChat platform, as a way of implementing telemedicine, can facilitate multi-dimensional and high-frequency communication through various forms such as voice, images, and videos. With advantages such as timely communication, diverse education, and dramatic health education. Medical staff provide personalized health guidance to patients on the WeChat platform, dynamically get information about disease conditions and medication use of patients, correct unhealthy habits, and further improve patient compliance. It has a significant prognostic effect on patients and effectively solves the drawbacks of telephone follow-up and outpatient follow-up [29]. From our research, we can observe the impact of three types of follow-up management on medication adherence in asthma patients. Repeated measures ANOVA showed that with the extension of follow-up time, the adherence of three groups of patients improved. The pairwise comparison results among the three groups showed that the compliance scores of the WeChat follow-up group were better than those of the telephone and respiratory outpatient clinics follow-up groups at 6 and 12 months after follow-up (P < 0.05). This may be related to the WeChat platform regularly pushing the introduction of inhaled drugs and the operation video of inhaler devices. Patients in the telephone follow-up group can only be followed up through voice communication, making it difficult to obtain videos of inhalation devices, which affects their medication adherence.In addition, medical staff provide face-to-face guidance to patients on inhaled medication, enabling them to learn inhalation medication and use inhalation devices correctly, and improve medication compliance compared to telephone groups.
The incidence of psychological disorders in asthma patients ranges from 18 to 49%, but only 6.5% and 8.5% of patients are clinically diagnosed with anxiety and depression [30–32]. Asthma combined with psychological disorders can seriously affect the symptom control and treatment of asthma patients [33]. A meta-analysis shows that [34], compared to patients without depression/anxiety, patients with depression/anxiety had a higher risk of asthma (OR = 3.2) compared to patients without asthma, asthma patients have a higher risk of depression and anxiety (OR = 1.5). In this study, repeated measures ANOVA showed that with the extension of follow-up time, the depression scores of the three groups of patients decreased. Pairwise comparison between groups showed that the depression scores of the WeChat follow-up group were lower than those of the telephone and respiratory outpatient clinics follow-up groups at 6 and 12 months after follow-up (P < 0.05). Due to the WeChat follow-up provide continuous emotional support for patients. Medical staff maintain regular communication with patients through WeChat, understand their troubles and demands, and provide psychological counseling and comfort. Emotional support can effectively alleviate patients loneliness, helplessness, and depression. This is similar to the results of Cabrerizo et al., after implementing WeChat follow-up, the depressive symptoms of asthma patients were significantly relieved [35].
GETE is a simple and intuitive tool for evaluating the effectiveness of asthma treatment. The repeated measures ANOVA results showed that the overall efficacy of asthma control and treatment improved significantly in the three follow-up groups at 1 month of follow-up, and was better than in 1 month of follow-up. This result emphasizes the importance of continuous follow-up in controlling asthma symptoms and treatment effectiveness. The research results are consistent with Saeed et al. [36], who emphasized the positive effect of continuous use of inhalation devices on reducing asthma symptoms in patients.
Quality of life is an auxiliary indicator in the treatment and control of asthma [37–39]. In this study, the quality of life scores of WeChat follow-up patients increased after 6 and 12 months of follow-up, and were higher than those of telephone follow-up and respiratory outpatient clinics follow-up groups. This indicates that WeChat follow-up significantly improve the quality of life .The reasons include: Firstly, the WeChat platform enables real-time communication between doctors and patients. On the WeChat platform, medical staff can promptly answer patients’ questions and provide personalized guidance and advice to patients; Secondly, medical staff regularly promote asthma disease management knowledge on the WeChat platform, enhance patients’ self-management abilities, and reduce the risk of acute asthma attacks; Finally, the convenience of WeChat follow-up reduces the cost of follow-up for patients, improves follow-up compliance, and promotes the improvement of quality of life. This is similar to the study of Davis et al. [40], who suggested that using smartphone applications for follow-up can help asthma patients improve quality of life.
The results of this research showed that at the end of the follow-up, WeChat follow-up has significant advantages in asthma patient management, with overall satisfaction (97.27%) significantly higher than telephone and respiratory outpatient clinics follow-up(P < 0.05), and can effectively reduce the risk of acute attacks. The hospitalization rate and emergency visit rate in the WeChat group were lower than those in telephone and respiratory outpatient clinics follow-upafter 12 months (P < 0.05). This is related to the fact that WeChat allows patients to consult about changes in asthma symptoms at any time, and doctors can adjust treatment plans in a timely manner to avoid worsening of the condition. At the same time, regular medication reminders and disease management knowledge may significantly improve patients’ treatment compliance and self-management abilities. Therefore, WeChat follow-up significantly improves the satisfaction of asthma patients and reduces the risk of acute attacks.
This study compared the effects of WeChat follow-up, telephone follow-up, and respiratory outpatient follow-up on the control level of asthma patients, with a focus on the comprehensive outcome of improving ACT scores and reducing acute attacks (hospitalization/emergency). The results showed that the WeChat group was significantly better than the telephone group and outpatient group in asthma control and clinical outcomes, supporting the advantages of mobile health management in chronic diseases. At the end of the study, the proportion of patients with ACT ≥ 20 and no acute onset in the WeChat group was significantly higher than that in the telephone group and outpatient group (P < 0.05), consistent with the trend of changes in ACT scores (P < 0.05). This result may be attributed to WeChat’s real-time interaction, personalized reminders, and convenient doctor-patient communication, which have improved patient compliance and self-management abilities. The results of this study are consistent with Xiao et al.‘s meta-analysis [41], which showed that mobile health intervention can improve asthma control rate (OR = 1.8).
WeChat follow-up education management has shown good results in asthma symptom control, improving quality of life, psychological state, and satisfaction. This is related to the convenience, real-time, and interactivity of telemedicine models. Through telemedicine follow-up management, patients can obtain asthma related-knowledge at any time and communicate with medical staff in a timely, which helps to better manage their condition.
This study also has limitations: the samples in this study were all from the same research center, which may result in selection bias. Asthma is a heterogeneous disease with complex pathogenesis and different phenotypes and subtypes. This study did not stratify asthma by phenotype (such as allergic/non allergic), baseline severity, or comorbidities, which may mask differences in intervention effects among different subgroups. Therefore, in the future, multicenter studies will be conducted to validate the effectiveness of personalized hierarchical management.
Conclusion
Both traditional respiratory outpatient clinics follow-upmanagement and telemedicine can provide long-term benefits for asthma patients. However, WeChat-based follow-up has demonstrated superior effectiveness in improving asthma control, enhancing medication compliance, and improving quality of life compared to conventional telephone follow-up and outpatient management groups. These findings suggest that WeChat follow-up could serve as an effective tool for long-term asthma management, particularly in resource-limited healthcare settings.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Acknowledgements
Not applicable.
Abbreviations
- GINA
Global Initiative For Asthma
- BMI
Body Mass Index
- Kg
Kilograms
- ACT
Asthma Control Test
- AQLQ
Asthma Quality of Life Questionnaire
- BDI-II
Beck Depression Inventory-II
- GETE
Global Evaluation of Treatment Effectiveness
- MARS-A
Medication Adherence Report Scale for Asthma
Author contributions
The paper writing and data collection were completed by Zhi Lu and Caixia Zhang. The design and supervision of the entire study were carried out by Da Liu and Hongzhong Yang. Muyun Yan, Jun Liu, and LuYang conduct regular follow-up on patients, All authors reviewed the manuscript.
Funding
This work was supported by the National Natural Science Foundation of China (82300042), Hunan Province Science and Technology Plan Project (2021SK53401), and the University of South China Clinical Research 4310 Program (20214310NHYPY04), Project of the National Health Commission of China (WKZX2023HK0132).
Data availability
The datasets used and analysed during the current study will be available from the corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
This study has been approved by the Ethics Committee of the Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China (Approval No: 2024-086)and was in accordance with the Helsinki Declaration. Informed consent was obtained from all patients involved in this study.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The datasets used and analysed during the current study will be available from the corresponding author on reasonable request.