Van der Meer 2009.

Methods	Randomised controlled trial
Participants	200 adults with physician‐diagnosed asthma, age 18 to 50, prescription of inhaled corticosteroids for at least 3 months in the previous year
Interventions	There was a 2‐week baseline period where patients familiarised themselves with the technology before randomisation. Then patients who were randomised to receive intervention used an Internet‐based self‐management program. They measured FEV1 daily and reported the highest of 3 measurements before taking their medication. They complete the Asthma Control Questionnaire (ACQ) once a week and reported symptoms via internet or text. Patients monitored their asthma using the special website or via text on a mobile phone then used an Internet‐based asthma treatment plan and online education, including asthma news, frequently asked questions and other information. Patients could also communicate with a specialised asthma nurse either using the web or telephone. The ACQ score fed into an algorithm and patients received one of 4 treatment messages. Control patients had access to the part of the website on which a diary of symptoms and exacerbations was kept.
Outcomes	1. Educational outcomes including asthma knowledge assess via the 12‐item Consumer Asthma Knowledge Questionnaire 2. Inhaler technique (standardised checklist of the Dutch Asthma Foundation) 3. Average number of medication changes per patient 4. Healthcare provider contacts including physician visits, telephone contacts and web communications 5. Clinical outcomes including 32‐item Juniper adult AQLQ, Asthma Control Questionnaire, symptom‐free days, pre‐bronchodilator FEV1, daily inhaled corticosteroid dose and exacerbations
Notes	The study was performed in Dutch. It would have been useful to know the seasonal time of year at which the results were recorded as asthma can worsen in cold weather or with pollen counts.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	"patients were randomly assigned using a computer‐generated permuted‐block scheme"
Allocation concealment (selection bias)	Unclear risk	"Allocation took place by computer after collection of the baseline data ensuring concealment of allocation." It is not clear whether this was central allocation
Blinding (performance bias and detection bias) All outcomes	High risk	No blinding of intervention, outcome assessor or data analyser
Incomplete outcome data (attrition bias) All outcomes	High risk	200 adults were randomised, after 12 months there remained 92 in the control group and 91 in the intervention group. 9 patients withdrew consent and 8 were lost to follow up. They analysed complete cases and did not impute missing values
Selective reporting (reporting bias)	Low risk	No evidence of selective reporting
Other bias	Low risk	No evidence of further systematic bias