Clinical effect on uncontrolled asthma using a novel digital automated self-management solution: a physician-blinded randomised controlled crossover trial

Abstract

IntroductionAsthmaTuner is a novel self-management system consisting of a patient app, a cloud-based storage solution and a healthcare interface. Patients use Bluetooth spirometers to measure lung function (forced expiratory volume in 1 s) and can register symptoms. They then receive immediate feedback on asthma control and an image of the correct inhaler(s) to use and the dose. The aim of this pilot study was to evaluate the effect of AsthmaTuner on symptom control and adherence compared with conventional treatment.Material and methodsThis multicentre physician-blinded crossover trial randomised patients in two groups that started with 8 weeks of AsthmaTuner or conventional treatment using a personalised printed treatment plan, with 2 weeks of washout between the crossover treatments. Participants in a primary or paediatric care setting in Sweden with asthma diagnosis, uncontrolled symptoms and Asthma Control Test (ACT) score <20 points were included. Symptom control was analysed using t-tests for the difference between the group means of the sums of ACT scores at each treatment end-visit, with 95% confidence intervals. Medical Adherence Report Scale (MARS) scores captured differences in adherence (remembering to take asthma medication) between treatment periods.ResultsThe study population consisted of 77 patients (60% females). The ACT score significantly improved with AsthmaTuner compared with conventional treatment (mean ACT difference 0.70, 95% CI 0.06–1.34; p=0.03). Adherence did not improve significantly in all participants, but did improve among those in primary care who used AsthmaTuner an average of once a week or more compared with conventional treatment (mean MARS difference 0.45, 95% CI 0.13–0.77; p=0.01).ConclusionsAsthmaTuner improved symptom control in patients with uncontrolled asthma compared with conventional treatment.

Targeting excessive avoidance behavior to reduce anxiety related to asthma: A feasibility study of an exposure-based treatment delivered online

“…The digital spirometer is a small device that is connected to a smartphone application. Asthma Tuner has been evaluated in a primary care population ( Ljungberg et al, 2019 ). The device was posted to the participants with instructions to use the Asthma Tuner daily for five days before pretreatment and five days after posttreatment.…”

A scoping review of mHealth monitoring of pediatric bronchial asthma before and during COVID-19 pandemic

“…Nonetheless, it was included as one of the examples of potential RPM concerning therapy adherence Kowatsch [45] 2021 Children and adolescents (10 - 15 years MAX, mHealth app (used by patient/parent or caregive dyad) and web portal (used by a healthcare professional) Uncontrolled intervention study NA Fedele [46] 2020 Children and adolescents (13 - 17 years) Responsive Asthma Care for Teens (ReACT), with modules for passive monitoring of therapy adherence, feedback with fine-tuning of the treatment plan, and promote self-efficacy Qualitative and/or mixed methods study NA Iio [47] 2020 Children (0 - 12 years), with individual groups for pre-school (0 - 6 years) and school (7 - 12 years) ages Prototype app, with modules for improved asthma self-control, educational content (tailored to different age groups), and symptom monitoring Qualitative and/or mixed methods study NA First author, last name reference number Publica-tion year Targeted patient group; targeted Childhood Asthma Control Test (C-ACT), if available Brief description of mHealth app or device or software or platform, or Internet-of-Things device Study design Additional comments Hsia [48] 2020 Children and adolescents (4 - 17 years), C-ACT < 20 ASTHMAXcel Adventures, an mHealth app developed in view of the latest evidence (i.e., evidence-based) by a multidisciplinary team, with patient input, to tailor asthma education to a pediatric patient App description, combined with an uncontrolled intervention study NA van der Kamp [31] 2020 Children and adolescents (4 - 14 years) Utilized different Internet-of-Things or mHealth devices: Actigraph WGT3X-BT wireless activity tracker (Actigraph inc. Pensacola, FL, USA), Spirobank advanced II portable spirometer (MIR Inc, Rome, Italy), Cohero Health smart inhalers (Cohero inc. New York, NY, USA), ECG by Emotion Faros 180° (Bittium, Oulu, Findland). No central integration via app or otherwise Controlled intervention study NA Ljungberg [38] 2019 Children (≥ 6 years), adolescents, C-ACT score < 20 AsthmaTuner (MediTuner, Stockholm, Sweden), certified cloud computing-based platform with web portal and an mHealth app. This platforms aims at promoting asthma self-management and education.…”

The present and future of inhalation therapy for the management of obstructive airway diseases: Emphasis on pressurized metered-dose inhalers

“…In New Zealand, the use of an inhaler with an adjusted electronic monitoring system with audiovisual reminder functions led to significant improvements in adherence to inhaled corticosteroids in school-aged children with asthma (84% vs 30% adherence in the control group) 75 . In Sweden, in a multicenter, physician-blinded, crossover, randomized, 8-week long trial, the implementation of a novel self-management system consisting of a patient app, a cloud-based storage solution and a healthcare interface, where patients use Bluetooth® spirometers to measure lung function, register symptoms, and receive instant feedback on asthma control and an image of the correct inhaler(s) to use and the dose, improved symptom control in patients with uncontrolled asthma compared with conventional treatment 76 .…”