Improvement in Asthma Control Using a Minimally Burdensome and Proactive Smartphone Application

Abstract

BACKGROUND Integrated chronic disease treatment models that enable patient self-care and shared treatment decision making have recently been shown to improve medication adherence and outcomes. Smartphone applications (apps) are a readily available means to enable this model, although sustained user engagement remains a challenge. OBJECTIVE To assess the efficacy of improving asthma control using a proactive smartphone app without required regular inputs. METHODS We designed a minimally intrusive smartphone app to provide individualized and timely support to patients with asthma based on the National Asthma Education and Prevention Program guidelines and Scripps management pathways. In this proof-of-concept study, we enrolled 60 adults with poorly controlled asthma to test the usability and effectiveness of this app over a 4-month period. The Asthma Control Test survey was used to assess control before, during, and after app use. As a corollary, a retrospective chart review was also used to assess changes in lung function and prescribed courses of systemic corticosteroids. RESULTS Our patients, with a mean age of 50 years, reported an improvement in Asthma Control Test scores from 16.6 (inadequate to poor) to 20.5 (controlled) over the study period. Concurrently, there was a 7.9% absolute increase in FEV1, while courses of systemic corticosteroids decreased from 0.5 to 0.3 courses per 6-month period. Fifty-eight of 60 patients completed the final survey, with high satisfaction reported. CONCLUSIONS This app improved asthma control in a cohort of patients with uncontrolled asthma (age range, 17–82 years), while minimizing burdensome inputs and proactively providing individualized teaching and treatment support. The app and treatment model are scalable to cost-effectively manage chronic disease.

Patient-Facing Mobile Apps to Treat High-Need, High-Cost Populations: A Scoping Review

“…Another randomized controlled study published in 2016 found that overweight and obese adults who used a social support app lost on average 3 kg more than patients using a self-monitoring control app over the course of the study [59]. Evidence from other recent trials has demonstrated the ability of apps to reduce consumption of sugar-sweetened beverages in women and nutrient-poor foods in men, increase activity level and reduce fatigue following stroke, and improve respiratory parameters with a reduction in corticosteroid usage among individuals with uncontrolled asthma [60-62]. …”

The efficacy of a mobile phone application to improve adherence to treatment and self-management in people with chronic respiratory disease in Romanian population – a pilot study

“…points. (11) Although it have been suggested that self-management effectiveness is reduced when assessed over long-term follow-up (24), this study showed that patients had a good compliance and asthma control has been improved in a period over one year. A possible explanation for this situation could be the fact that the patients knew they were in a study and that they had to come for re-evaluation every three months, while in the study of Kauppinen et al, the patients were assessed for a much longer period (> 10 years).…”

“…Moreover, the authors emphasized that the use of the application was associated with a statistical and clinical improvement in ACT scores. (11) Results demonstrated an increase of 3 points in the mean ACT score after only 5 weeks of application use. The patients with uncontrolled asthma (an ACT score under 20 points) benefited the most, with an mean increase of 5.7…”

Moving towards Sustainable Electronic Health Applications

“…The lack of certainty in the interventions independent sustainability is one of the leading factors responsible for this resistance [4]. Electronic health apps may hold great promise for better health tracking [5], providing education [6], changing and enforcing health behaviors [7], and monitoring treatment adherence [8], however despite these benefits, they are still not being used [9]. This can be attributed due to nine key design barriers that are outlined in Chindalo et al literature review [9] (Table 1).…”