Adherence reminders for children can guide adolescents in their self-management of asthma.6 A study of 220 school-age children (aged 6-15 years) demonstrated that 84% of patients who received inhalers equipped with audio visual reminders were adherent to their inhalation therapy compared with  the 30% who received standard care (P <.0001).6

Biomedical engineers are testing the feasibility of predicting asthma attacks in children. With the aid of smartwatches, smartphones, sensors, and real-time environmental data, a crying dragon graphic on a smartwatch will warn children at risk for an imminent asthma attack so that they might take preventive measures.7 Such technology could avert a huge medical and economic burden for children and their families.

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“We hope to provide clinicians and patients with a low-cost self-management tool that can allow for individualized risk assessments and recommendations, as asthma is a multifaceted disease with different physiological and environmental triggers that affect each individual differently,” explains Christine E. King, PhD, assistant professor in the department of biomedical engineering at the University of California, Irvine.

Smartphones also figure into another soon-to-be launched trial that will strengthen the teen-caregiver pair to enable children aged 12 to 15 years to take greater responsibility for their asthma management.8 The AIM2ACT study’s goals are to determine the feasibility of the technology to provide relevant outcomes data and for participants to offer feedback that will guide future trial designs.8

“We hope physicians will provide patients with tailored feedback from the study and discuss specific areas for improvement in asthma self-management,” explains principal investigator David Fedele, PhD, assistant professor in the department of clinical and health psychology at the University of Florida, Gainesville. “AIM2ACT aims to help adolescents as they take on new responsibilities with their asthma care while also fostering helpful support from their caregivers. After completing AIM2ACT, we hope adolescents will begin to develop and master asthma self-management behaviors and collaborate more effectively with their families as they manage their asthma.”

Technology Acceptance Is Universal

While clinicians are gaining a better understanding of patients’ challenges with managing asthma, participants in clinical trials seem to embrace the technology.1 A small study of 7 adolescents aged 11 to 18 years with asthma reported enthusiastic acceptance for devices that reminded them to use their inhalers.9 In a focus group, patients said that the devices helped them to adhere to their inhaler regimen and all who used the technology would recommend it to others with asthma.9 

Adults, too, embraced technology to aid them in their quest to avoid asthma exacerbations and emergency hospital visits.10 In an assessment of adults (n=18; mean age, 39 years), most liked having the devices remind them to use their inhalers and many benefited from good habits that the devices instilled.10

Should clinicians rush to adopt technology?

“I would advise pulmonologists to educate themselves on the utility of mHealth and the benefits of using these types of programs,” says Dr Fedele. “mHealth technologies offer opportunities for families to learn more about managing pediatric chronic illnesses, even after they have left their clinic appointments.”

While mobile devices that measure multiple parameters may sound enticing, Dr Honkoop cautions physicians that the evidence for these systems is evolving. “I would advise clinicians to be careful at this time and maybe go for single measurement system such as pollen counts, peak flow, or FEV1 data using Bluetooth-connected measurement devices.”


  1. Bonini M, Usmani OS. Novel methods for device and adherence monitoring in asthma [published online October 13, 2017]. Curr Opin Pulm Med. doi:10.1097/MCP.0000000000000439
  2. Kikidis D, Konstantinos V, Tzovaras D, Usmani OS. The digital asthma patient: the history and future of inhaler based health monitoring devices. J Aerosol Med Pulm Drug Deliv. 2016;29(3):219-232
  3. Price DB, Román-Rodríguez M, McQueen RB, et al. Inhaler errors in the CRITIKAL study: type, frequency, and association with asthma outcomes. J Allergy Clin Immunol Pract. 2017;5(4):1071-1081.e9
  4. Honkoop PJ, Simpson A, Bonini M, et al. MyAirCoach: the use of home monitoring and mHealth systems to predict deterioration in asthma control and the occurrence of asthma exacerbations; study protocol of an observational study. BMJ Open. 2017;7:e013935
  5. Tinschert P, Jakob R, Barata F, Kramer JN, Kowatsch T. The potential of mobile apps for improving asthma self-management: a review of publicly available and well-adopted asthma apps. JMIR Mhealth Uhealth. 2017;5(8):e113
  6. Chan AH, Stewart AW, Harrison J, Camargo CA Jr, Black PN, Mitchell EA. The effect of an electronic monitoring device with audiovisual reminder function on adherence to inhaled corticosteroids and school attendance in children with asthma: a randomised controlled trial. Lancet Respir Med. 2015;3(3):210-219
  7. Hosseini A, Buonocore CM, Hashemzadeh S, et al. Feasibility of a secure wireless sensing smartwatch application for the self-management of pediatric asthma. Sensors (Basel). 2017;17(8):1780
  8. Fedele DA, McConville A, Graham Thomas J, et al. Applying interactive mobile health to asthma care in teens (AIM2ACT): development and design of a randomized controlled trial [published online October 3, 2017]. Contemp Clin Trials. doi:10.1016/j.cct.2017.09.007
  9. Cushing A, Manice MP, Ting A, Parides MK. Feasibility of a novel mHealth management system to capture and improve medication adherence among adolescents with asthma. Patient Prefer Adherence. 2016;10:2271-2275
  10. Foster JM, Reddel HK, Usherwood T, et al. Patient-perceived acceptability and behaviour change benefits of inhaler reminders and adherence feedback: a qualitative study. Respir Med. 2017;129:39-45.