Adult patients with asthma were found to be effectively screened for symptoms and provided appropriate interventions with the use of digital communication technology (DCT) tools, according to a study published in Medical Care.

With this pragmatic, randomized controlled trial, the Breathewell Study, investigators sought to evaluate whether the use of DCT compared with usual care can reduce the health care clinician burden without increasing the rate of asthma-related exacerbations in patients with asthma in a large, integrated health care system. Standard care was delivered by a group of asthma care managers (ACMs) who contacted patients requesting a refill of their asthma medication (usually a β2-agonist [BA]) when the request was issued frequently (ie, more often than every 60 days), or when the patient was requesting a BA but no asthma controller medication (typically an inhaled corticosteroid) in the previous 4 month-period.

A total of 14,978 adult patients (≥18 years; average age, 49 years) with asthma were randomly assigned to receive usual care (n=4979) or 1 of 2 DCT interventions (text/phone call outreach: n=4953; email outreach: n=5046). All participants had an asthma diagnosis at the time of randomization, and no history of chronic obstructive pulmonary disease. The primary study outcomes were asthma-related health care resource utilization (eg, asthma nurse contacts), asthma medication use, and asthma exacerbations.

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In text/phone call and email communications, the patients were informed that they were being contacted as a result of their request for a BA medication refill. They were asked the following question: “Other than when you’re getting ready to exercise, during the past 4 weeks have you used your quick reliever inhaler 2 or more times a week?” If the response was “no,” the patient was thanked, the communication was terminated, and a notation was inserted in the individual’s electronic health record (EHR). If the response was “yes,” a request for patient contact was forwarded to the ACM via the participant’s EHR.

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In this cohort, 1933 patients met BA overfill (BAO) criteria (n=657 in the text/phone call group; n=621 in the email group; and n=655 in the usual care group). Among participants with BAO, 215 were excluded, leaving 1718 patients across the 3 groups who met BAO criteria (n=557 in the text/phone call group; n=523 in the email group; and n=638 in the usual care group).

Some of the participants had >1 BAO and thus required >1 contact. Overall, there were a total of 2847 BAO intervention events reported. Of these events, 41% that would have necessitated an ACM contact with the use of usual care were successfully resolved with DCT outreach.

“This study demonstrated that a DCT implemented in a large integrated health care organization can successfully reach out to adult asthma patients to screen for increasing symptoms and facilitate intervention,” concluded the study authors. “DCT interventions, when incorporated with an EHR system, can take over time-consuming tasks previously handled by clinicians.”


Bender BG, Wagner NM, Shoup JA, et al. Adults with asthma experience no increase in asthma-related exacerbations when digital communication technology tools are employed to offset provider workload: a pragmatic randomized trial. Med Care. 2020;58(4):352-359. doi: 10.1097/MLR.0000000000001265