Using Telemedicine to Care for the Asthma Patient

Abstract

Purpose of Review To review the data supporting the use of telemedicine (TM) and to provide practical guidance for practitioners to optimize the care of their asthmatic patients. Recent Findings Previous to the pandemic, TM was little used in various aspects of asthma care. Since the pandemic, TM has been increasingly used in new ways to care for asthma patients at various locations. In addition to direct-to-consumer visits for asthma care, other forms of telehealth visits have been increasing such as facilitated visits, asynchronous, remote patient monitoring, e-consults, and mHealth. Moreover, patient and provider satisfaction with the use of TM has been increasing and is comparable at times with face-to-face visits. In this review, best practices for starting a telemedicine asthma service with patients at home, distant clinic sites, and various other locations, including school-based asthma programs, are reviewed. Summary TM is a valuable adjunct to face-to-face visits for asthma care. Following the recommended best practices can strengthen the implementation of a telemedicine asthma program (TMAP) into clinical practice. Providers must be vigilant in keeping current with the various nuances required for asthma telemedicine care in preparation for the post-pandemic environment.

Use of Telemedicine Healthcare Systems in Children and Adolescents with Chronic Disease or in Transition Stages of Life: Consensus Document of the Italian Society of Telemedicine (SIT), of the Italian Society of Preventive and Social Pediatrics (SIPPS), of the Italian Society of Pediatric Primary Care (SICuPP), of the Italian Federation of Pediatric Doctors (FIMP) and of the Syndicate of Family Pediatrician Doctors (SIMPeF)

“…Two different modes of telemedicine application can be distinguished, represented by the “synchronous” and the “asynchronous” modes. The first one takes place in real time and can be applied in direct mode or through facilitators, able to act as an interface between the patient and the physician [ 20 , 21 ]. The second takes place in deferred mode, through a two-way flow (from the patient to the health professional and vice versa) of information, using digital tools such as smartphones, tablets or PCs interfaced with portable medical devices (e.g., spirometers) or stationary (monitors connected to transmission centers), but also in the form of video recordings, tutorials and e-consulting useful for educational purposes for the patient and his or her family.…”

“…Applied in particular to asthma, as to other pulmonological diseases, the applicability of telemedicine in the diagnostic phase clashes with the difficulty of carrying out a complete physical examination remotely, beyond a simple inspection through monitors and video cameras (e.g., evaluation of skin color and respiratory dynamics) and auscultation based on the perception of noises that can be heard at a distance (presence of wheezing, stridor, hoarseness, etc.) [ 21 ]. On the other hand, telemedicine may be easier to use when the clinical picture is limited to skin diseases (atopic dermatitis, urticaria and drug reactions), in which the web-based assessment of the type of lesion supplemented by the main anamnestic data (mode and time of onset or presence of itching) can alone allow a diagnosis.…”

Effect of Disease Severity, Age of Child, and Clinic No-Shows on Unscheduled Healthcare Use for Childhood Asthma at an Academic Medical Center

“…Since childhood asthma is a chronic condition, both types of information could enable a healthcare organization to develop a comprehensive, strategic plan for addressing the burden of unscheduled healthcare use for childhood asthma. For example, if clinic no-shows are found to be a significant predictor of unscheduled healthcare use among children in the short term (12 and 18 months), then efforts could be made to implement telehealth or mobile van services for asthma outpatient care to reduce clinic no-shows in the short term across all ages and asthma severity levels [ 18 , 19 , 20 , 21 ]. Alternatively, if younger children with severe-persistent asthma are significantly more likely to use unscheduled healthcare in the longer term (24 months), then comprehensive efforts could be undertaken to develop a provider–patient partnership to facilitate patient-centered asthma control (including medication management and environmental control) for younger children with severe-persistent asthma [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 22 ].…”

Remote visits for severe asthma patients after the COVID-19 pandemic: how to address the challenge?

“…The impossibility of face-to-face follow-up visits during the COVID-19 pandemic and the need to provide patients with ongoing medical care led to an increase in remote follow-up consultations for the management of patients with chronic diseases such as severe asthma 1 , 2 , 3 , 4 , 5 . As a consequence, today there is a new reality in severe asthma management, with a prominence of remote visits as a good alternative for ensuring that follow-up is compatible with work-life balance while ensuring the quality and continuity of healthcare.…”

“…Stakeholder acceptance, integration into the electronic health record, and cost-effectiveness are keys to success 12 . Work is now under way to identify factors that will accelerate the implementation of telemedicine in respiratory medicine 3 , 8 and contingency plans are being developed to include it as a standard of care for asthma patients 1 .…”