The use of electronic asthma action plans (eAAPs) supported by automated text messaging services (SMS) has been associated with improved disease control and fewer exacerbations, according to the results of a pilot randomized controlled trial conducted in Canada and published in the Journal of Asthma.
Investigators sought to compare eAAPs supported by SMS with written asthma action plans (AAPs) on evaluating acceptability and improvements in asthma control. They postulated that patients in the eAAP group would experience more improvements in their quality of life (QoL) and asthma control, along with decreased asthma exacerbations.
Patients with physician-diagnosed asthma who had experienced ≥1 exacerbation in the prior 12 months were recruited for the study. All participants received individualized action plans and were randomly assigned to either the intervention (eAAP) or control (AAP) group. All individuals in the intervention arm received weekly SMS, prompting assessment of their asthma control and viewing their eAAP. The researchers evaluated the applicability of Telehealth platforms on asthma control, asthma exacerbations, and QoL over 12 months.
Telehealth (which is also called eHealth and when using mobile devices, mHealth) is a general term that refers to the delivery of healthcare services, information, and education through telecommunication technologies.
A total of 106 patients were enrolled in the trial, with 52 in the eAAP group and 54 in the AAP group. Clinical outcomes of the study were divided into primary (ie, reduction in exacerbations) and secondary outcomes (ie, improved QoL and asthma control).The cumulative response rate with respect to all weekly SMS check-ins was 68.4%. During the intervention, 28% of patients checked into their eAAP. Fewer exacerbations were reported in the eAAP arm (18%) compared with the AAP arm (relative risk [RR], 0.82; 95% CI, 0.49-1.36; P =.44).
The mean score for asthma control was 4% higher in the eAAP group vs the AAP group (RR, 1.04; 95% CI, 0.83-1.30; P =.73). Additionally, the mean score for QoL was 5.5% higher in the eAAP group vs the AAP group (RR, 1.06; 95% CI, 0.87-1.28; P =.59). Neither of these findings was statistically significant, however.
The investigators concluded that the sample size of the study was inadequate to demonstrate a significant difference between the groups. Based on the results of this pilot study, however, larger and appropriately powered randomized controlled trials are planned.
Poureslami I, Shum J, Lester RT, Tavakoli H, Dorscheid DR, FitzGerald JM. A pilot randomized controlled trial on the impact of text messaging check-ins and a web-based asthma action plan versus a written action plan on asthma exacerbations [published online July 13, 2018]. J Asthma. doi:10.1080/02770903.2018.1500583