Self-management app may improve outcomes in kids with persistent asthma

By Will Boggs MD

NEW YORK (Reuters Health) - 16/5/2019

AsthmaTracker, an electronic self-monitoring app for children with asthma, appears to increase participation in self-monitoring and improves asthma outcomes, according to a prospective study.

Despite widely recognized guidelines, more than 50% of children with asthma have poorly controlled disease that leads to poor quality of life, more frequent exacerbations and frequent acute healthcare use.

Dr. Flory L. Nkoy of the University of Utah, Salt Lake City, and colleagues developed AsthmaTracker and assessed the impact of its implementation in nine general pediatric ambulatory clinics that enrolled 325 children with persistent asthma.

The features of AsthmaTracker include automated reminders to sustain use; real-time results graphing; alerts for patients and parents and primary-care physicians' offices for early signs of asthma control deterioration; and real-time recommendations.

The average child quality-of-life score increased significantly from 79.1 at baseline to 90.9 at three months, 90.0 at six months and 90.6 at 12 months.

Overall average asthma control scores improved significantly from 18.8 at baseline to 22.3, 22.8, 22.8, and 22.9 at first, second, third and fourth quarter, respectively, the researchers report in Pediatrics, online May 16.

The use of AsthmaTracker was associated with significantly fewer interrupted or missed school days and fewer interrupted or missed workdays.

Average admission rates decreased by 32% and average oral corticosteroid (OCS) use decreased by 26% between pre- and post-intervention.

In a comparison between AsthmaTracker users and 603 matched controls, admission rates were 59% lower and OCS use was 35% lower among users than among controls.

"Dissemination of this proactive care model can lead to major improvements in asthma care and outcomes, with potential for significant reductions in asthma-related healthcare costs," the researchers conclude.

Dr. Umakanth Katwa from Boston Children's Hospital and Harvard Medical School, who recently reviewed asthma management in the era of "smart-medicine," told Reuters Health by email, "I think every persistent-asthma patient needs to be monitored on an ongoing basis to assess asthma control. However, children with moderate-severe persistent asthma with a history of frequent use of OCS seem to benefit the most. If these are monitored over 12 months, one can suspect during which season asthma tend to be worse (low asthma control test (ACT) scores), and hence the provider can empirically increase the dose of controller medication at the start of that season for better asthma control."

"In an era of digital health and artificial intelligence, chronic diseases such as asthma can be effectively monitored longitudinally by the parents (allowing intervention) much earlier to prevent full-blown flare-up," he said. "In addition to clinical-based apps like this one, Bluetooth-based technology connected to inhalers can monitor use of inhalers (hence one can assess compliance and also frequency of usage of rescue medications to assess asthma control), monitors (like Google home if such technology is built into it) and smart garments (Ts) with embedded sensors to monitor cough and respiratory rate can add additional clinical parameters."

"With this information, along with help of telemedicine platforms," added Dr. Katwa, who was not involved in the new study, "physicians can provide treatment even faster, leading to even better outcomes without missing any further work/school or need to travel."

Dr. Richelle C. Kosse from Utrecht University, in the Netherlands, and colleagues recently demonstrated the benefits of an interactive mobile health intervention on adherence in adolescents with asthma. She told Reuters Health by email, "The mean age of the 325 participants (in the new study) was 7.9 years; thus, the app might be beneficial for this population. However research towards adolescents with asthma (age 12-18 years) might also be interesting, because during adolescence, children become independent individuals, and they might need extra help with their asthma self-management. Based on this article, the electronic-AsthmaTracker with the different features might be useful for this."

"The patient's satisfaction is unknown in this study," said Dr. Kosse, who was not involved in the research. "The parents' satisfaction score was high, but slightly decreased over time. It would be interesting to know what the children thought of it, in particular, the older children (age >12 years)."

AsthmaTracker is available online at https://asthmatracker.utah.edu/public.

The study had no commercial funding and the researchers declared no conflicts of interest. Dr. Nkoy did not respond to a request for comments.

SOURCE: https://bit.ly/2EcpgOG

Pediatrics 2019.

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