Jan 2007.

Methods	Randomised controlled trial
Participants	This study was conducted in Taiwan where 73% of adults have personal computers and 54% of families have internet access. Children were eligible for inclusion in the study if they were between the ages of 6 and 12 years, had access to the Internet by their caregivers and had a physician’s diagnosis of asthma. Other chronic conditions such as bronchopulmonary dysplasia were excluded. 164 paediatric asthma patients were enrolled.
Interventions	The intervention group participants were given “Blue Angel for Asthma Kids”, an Internet‐based paediatric asthma monitoring program for asthmatic children plus their parents. The system has symptom and peak flow diaries and individual Asthma Action Plan suggestions based on the GINA (Global Initiative for Asthma) guidelines. These data can be shared with the patient’s physician who can give feedback via telephone or email. The peak flow meter provided to the families could measure PEF and FEV1 and attached via a USB (Universal Serial Bus) connection to a computer. Control: Traditional treatment in an outpatient allergy and asthma clinic accompanied by a PEF meter and diary. This group also received asthma education as part of usual care including verbal and printed information. They were also given an Asthma Action Plan to aid decision making.
Outcomes	Outcome measures: 1. PEF records 2. Symptom diaries 3. Paediatric Quality of Life test was completed at baseline and after 12 weeks 4. Childhood Asthma Control Test, at baseline and 12 weeks 5. Caregiver Survey of Asthma Knowledge, before and after the trial 6. Measurement of patients’ adherence to treatment 7. Adherence to asthma diaries
Notes	—
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	“children and their caregivers, who were randomised”
Allocation concealment (selection bias)	Low risk	Sealed envelope
Blinding (performance bias and detection bias) All outcomes	High risk	No information is given as to how the outcomes of the groups were collected and whether outcome assessors were blinded to the allocation of the patients. This would, of course, not have been possible for the outcomes that were recorded by the Internet program but other outcomes which were recorded using questionnaires at baseline and 12 weeks.
Incomplete outcome data (attrition bias) All outcomes	High risk	Study power calculation required 100 children in each arm. 99 were randomised to the intervention arm and 97 were randomised to the control arm. Of the original sample of 196 children there were 184 invited to participate. 5 families were "too busy", " not interested" or found it "too complex to perform the diary card" 15 (6 control and 9 intervention participants) were excluded either at their request or because there was a lack of data due to internet failure. 7 families who dropped out were unavailable for comment. "baseline characteristics of children who did not complete the trial did not differ from those who did" The study reports that 82 intervention participants and 71 control participants returned for 12‐week follow up. This leave 4 participants unaccounted for.
Selective reporting (reporting bias)	High risk	Satisfaction questionnaires data not shown
Other bias	Low risk	No other bias apparent