Summary of findings for the main comparison. Summary of findings table 1.

Home telemonitoring and feedback vs usual care for people with asthma
Patient or population: people with asthma Setting: home Intervention: home telemonitoring with remote feedback from a healthcare professional Comparison: usual monitoring
Outcomes	Anticipated absolute effects* (95% CI)		Relative effect (95% CI)	Number of participants (studies)	Quality of the evidence (GRADE)	Comments
	Risk with usual monitoring	Risk with home telemonitoring and feedback
Exacerbations requiring oral corticosteroids 7.3‐month follow‐up**	399 per 1000	382 per 1000 (285 to 489)	OR 0.93 (0.60 to 1.44)	466 (4 RCTs)	⊕⊕⊝⊝ LOWa,b,c	2 child studies, 2 adult studies. Subgroup differences not significant (P value = 0.78) 2 child studies and 6 adult studies in ED analysis agreed with the OCS analysis (OR 0.75, 95% CI 0.36 to 1.58)
Exacerbations requiring hospital admission 7.8‐month follow‐up	Children (< 16 years)		OR 1.38 (0.51 to 3.68)	421 (4 RCTs)	⊕⊕⊕⊝ MODERATEc,d	4 child studies and 6 adult studies presented separately owing to significant subgroup differences (P value = 0.04) Telemonitoring beneficial for adults, but probably not for children
	38 per 1000	52 per 1000 (20 to 127)
	Adults (17 to 65 years)		OR 0.24 (0.06 to 0.94)	621 (6 RCTs)	⊕⊕⊕⊝ MODERATEc,d,e
	83 per 1000	21 per 1000 (5 to 79)
Asthma control Follow‐up varied from 3 to 12 months	Asthma control was reported in 3 different ways across 4 studies Summary of results in Comments column		‐	(4 RCTs)	⊕⊝⊝⊝ VERY LOWf,g,h	ACQi (MD ‐0.24, 95% CI ‐0.72 to 0.24) (2 adult studies); ACT 'well‐controlled' (29/60 vs 8/29) (1 adult study) (MD 0.09, 95% CI 0.92 to 1.10) (1 child study)
Serious and non‐serious adverse events	None of the studies explicitly reported serious or non‐serious adverse events as an outcome separate from asthma exacerbation outcomes		‐	(0 RCTs)	N/A	No studies
Asthma‐related quality of life (AQLQ)i 9.6‐month follow‐up 1 to 7, higher = better	Mean AQLQ score was 3.58***	Mean AQLQ score in the intervention group was 0.23 better (0.01 better to 0.45 better)	‐	796 (6 RCTs)	⊕⊕⊝⊝ LOWf,i
Lung function % predicted trough FEV1 higher = better 7.6‐month follow‐up	Mean predicted FEV1 was 68.4%***	Mean % predicted FEV1 in the intervention group was 7.21% higher (1.52 higher to 12.89 higher)	‐	149 (3 RCTs)	⊕⊕⊕⊝ MODERATE j	‐
Unscheduled healthcare visits 6.2‐month follow‐up	332 per 1000	329 per 1000 (155 to 565)	OR 0.99 (0.37 to 2.62)	430 (3 RCTs)	⊕⊝⊝⊝ VERY LOW c,k,l	Very unbalanced dropout in 1 study showing different effects from the other 2 (12% vs 57%)
* The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). ** With the exception of the asthma control outcome, where a range is given, follow‐ups are given in months as a weighted mean duration of studies in the analysis. *** Risk with usual monitoring was calculated as a weighted mean of scores in the control groups of studies contributing to the analysis. For the AQLQ analysis, this did not include the 2 studies reporting change from baseline. ACQ = Asthma Control Questionnaire; ACT = Asthma Control Test; AQLQ = Asthma Quality of Life Questionnaire; CI = confidence interval; FEV1 = forced expiratory volume in 1 second; MD = mean difference; OR = odds ratio; RCT = randomised control trial; RR = risk ratio
GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of effect but may be substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

^aA couple of studies carrying < 20% of the overall weight had high attrition and uncertainty with selection bias, but this was not judged to be serious enough to downgrade (no downgrade)

^bOne study could not be included because exacerbations were used as the unit of analysis rather than people with exacerbations, and the small number of studies in the analysis compared with the emergency department and hospital exacerbations analyses suggests that this may have been recorded and not reported (‐1 publication bias)

^cConfidence intervals include important benefit of either treatment, so it is difficult to interpret the result (‐1 imprecision)

^dRisk of bias was confined mostly to the blinding domains, which is unlikely to have affected this outcome. Uncertainty in the selection bias domains was not deemed serious enough to downgrade (no downgrade)

^eHeterogeneity between studies in the adult subgroup was high but not statistically significant, and all but one of the point estimates lay in the same direction, favouring telemonitoring (no downgrade)

^fStudies were generally at high risk of bias for the blinding domains, which may have affected results on subjective rating scales (‐1 risk of bias)

^gSerious inconsistency between the two studies reporting the ACQ and results across asthma control outcomes did not give a clear direction of effect (‐1 inconsistency)

^hImprecision varied across the 3 asthma control outcomes, but overall the effect was unclear owing to differences in direction, magnitude and confidence intervals (‐1 imprecision)

^j Child and adult studies were pooled, and important heterogeneity was noted (I² = 54%, P value = 0.06) (‐1 inconsistency)

^kTwo studies carrying most of the weight were judged to be at high risk of bias owing to high dropout; in particular, Cingi 2015 had 57% dropout in the control group compared with 12% in the intervention group (‐1 risk of bias)

^lCingi showed an effect in the opposite direction to that noted in the other two studies, which introduced important heterogeneity (I² = 73%, P value = 0.03) (‐1 inconsistency)

ⁱThe minimal clinically important difference (MCID) for both the Asthma Control Questionnaire (ACQ) and the Asthma Quality of Life Questionnaire (AQLQ) is 0.5 units