Review questionWhat is known about the evidence that web-based/online/computerised tools for self management of asthma can improve indices of asthma control, lung function, health care utilisation, patient quality of life, and patient satisfaction, and what helps or hinders the use of such interventions by patients, carers and health professionals. Objectives• To undertake a systematic review of all published reviews (quanti tative and qualitative) of web-based/online/computerised self-management asthma interventions.• To establish if the use of web-based/online/computerised self care interventions have been found to have a positive effect on asthma symptom scores, lung function, medication use, health care utilisation, or asthma quality of life scores.• To identify the presence of techniques in these interventions known to promote behavioural change e.g. educational information, self monitoring, attitudinal arguments, and the use of prompts.• To examine what factors, if any, have been identified as promoting or inhibiting the uptake and utilisation of online tools by patients, carers and practitioners? Searches• Databases to be searched: MEDL I NE, EMBASE, CINAH L, PsycINFO, ERIC, Cochrane Library (including CDSR, DARE, Central, and HTA databases), DoPHER and TROPHI (both produced by the EPPI Centre), Social Science Citation Index and Science Citation Index. These databases will be searched using a combination of subject headings where available (such as MeSH) and words in the t i tle and abstracts.The search strategy combines 3 facets of search terms:1. Online technology 2. Asthma 3. Self management/behavior change/patient experience Searches employing more general terms, such as respiratory t ract diseases, will be explored as they may identify records where in the full document i t becomes clear that patients with asthma are included.

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Macrolide antibiotics were discovered over 50 years ago and following their use as antimicrobials it became apparent that this group of antibiotics also possessed anti-inflammatory properties. Subsequent clinical trials showed benefits of macrolides as long-term adjuncts in the treatment of a spectrum of chronic inflammatory respiratory diseases, particularly diffuse panbronchiolitis, cystic fibrosis, post-transplant bronchiolitis obliterans and more recently chronic obstructive pulmonary disease (COPD). The evidence for efficacy of macrolides in the long-term treatment of chronic asthma and bronchiectasis is less well established. The mechanism(s) of action of macrolides in the treatment of these diseases remains unexplained, but may be due to their antibacterial and/or anti-inflammatory actions, which include reductions in interleukin-8 production, neutrophil migration and/or function. Macrolides have additional potentially beneficial properties including anti-viral actions and an ability to restore corticosteroid sensitivity. The increased prescribing of macrolides for long-term treatment could result in the development of microbial resistance and adverse drug effects. New macrolides have been developed which do not possess any antimicrobial activity and hence lack the ability to produce microbial resistance, but which still retain immunomodulatory effects. Potentially novel macrolides may overcome a significant barrier to the use of this type of drug for the long-term treatment of chronic inflammatory airway diseases.

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