Asthma Control With Mobile Health Initiatives

As technology advances, clinicians are getting a clearer picture of how patients with asthma control their disease. A systematic review of 21 studies revealed that mobile phones, smartwatches, home monitoring devices, inhaler trackers, and electronic reminders — collectively known as eHealth or mHealth — can improve the overall well-being of patients with asthma across the lifespan.¹

Technology Can Inform Clinicians

Inhalation therapy is the foundation of asthma treatment and is the most important aspect in controlling the chronic disease.^1,2 Because asthma requires constant vigilance and the consequences of uncontrolled asthma are tremendous, clinicians, patients, and researchers are eager to integrate technology into devices that patients already use.^1,2 

“The data gathered can be furthered processed to allow prediction of exacerbations and provide real-time information to patients and clinicians, who will then modify patients’  action plans according to the current needs, thus maximizing the effects of their treatment,” explains Antonios Χ. Lalas, PhD, electrical and computer engineer from Thessaloniki, Greece.

Given the more than 200 inhalers on the market, it is not surprising that there are many variations and poor techniques for using them.¹ The 3-year CRITIKAL observational study (n=4276) brought this important finding to light by reporting the type of mistakes patients with asthma made with their inhalers and how they affected asthma outcomes.³

Inadequate inspiratory effort was the most common mistake demonstrated by 32% to 38% of patients who used dry-powder inhalers.³ In the metered-dose inhaler cohort, 47% of patients did not inspire slowly and deeply. Other commonly observed techniques that led to poor outcomes were twist errors, insufficient head tilt, and inadequate exhalation to empty the lungs before using the devices.³

These observations underscore the need for better inhaler instructions and frequent patient reminders to use their inhalers correctly.³ “Many physicians tell me this [study] has reinforced the importance of checking inhaler technique and for those already doing so, reduced the number of things they need to focus on,” says David Price, MBBChir, MA, professor of primary care respiratory medicine from the University of Aberdeen, Scotland.

Dr Price offered the following suggestions for clinicians:

• Check inhaler technique
• Check that the lungs are emptied before inhaling and that the head is tilted slightly back for all inhalers
• For dry powder inhalers, ensure the patient is inhaling hard and fast
• For metered dose inhalers, ask the patient to start breathing in slowly and then actuate continuing to breathe in slowly until lungs are full 

Mobile devices can predict asthma outcomes, as measured by physiological, behavioral, and environmental inputs.⁴ Predicting asthma outcomes through such devices is the goal of the MyAirCoach study, a multinational trial, which will employ sensors, mobile phones, and home monitoring devices to alert clinicians to a patient’s deteriorating asthma status.⁴ Initially, patients enrolled in the 1-year study will be monitored daily for a month, and monthly thereafter.

“We hope to find a way to assess data that are automatically being collected from an individual patient and combine this to an individualized prediction of their asthma control and chance of asthma exacerbations in the near future,” explains Persijn Honkoop, MD, PhD, principal investigator and primary care physician at the University of Leiden in The Netherlands.

Beyond Electronic Nudges for Patients

Thanks to the ubiquity of mobile devices, patients have embraced technological assistance in managing their asthma. From mobile phones to every day wearable devices, evidence is mounting that technology can improve self-care, increase adherence to asthma regimens, and provide early warnings of worsening disease.¹

Although there are dozens of apps to help patients manage their asthma, Swiss researchers found a wide variation in quality in the 38 asthma apps for iOS and Android phones.⁵ They noted that the better quality apps had functions for tracking, assessment, and the potential for changing patient behavior through gamification.⁵ “Due to the broad spectrum of app quality we have encountered in our analysis, pulmonologists should only recommend apps to patients that they have reviewed themselves,” advise researchers Peter Tinschert, MSc, and Tobias Kowatsch, PhD, from the Center for Digital Health Interventions, Institute of Technology Management at the University of St. Gallen in Switzerland.