Asthma Ctrl SMART Trial

Improving Medication Adherence Using an Adaptive mHealth Intervention in Adolescents With Asthma.

The primary objective is to examine the efficacy of an mHealth adherence intervention (Asthma Ctrl) on adherence to daily inhaled corticosteroids as measured by electronically monitored adherence in adolescents with asthma. The secondary objective is to compare the effectiveness of three intervention strategies: 1. asthma management app (control); 2. Asthma Ctrl; 3. Asthma Ctrl+ on adherence, lung function, and health care utilization at post-intervention and 1- and 6-month follow-up. The third objective is to explore and contrast different challenges and combinations of challenges to identify which are most impactful in determining response to the three intervention strategies.

Study Overview

• Status: Not yet recruiting
• Conditions: Asthma in Children; Asthma Chronic
• Intervention / Treatment: Behavioral: Control; Behavioral: Asthma Ctrl; Behavioral: Asthma Ctrl+

Detailed Description

Our goal is to evaluate our promising mHealth intervention (Asthma Ctrl) that is easily accessible and tailored based on adherence barriers and to examine predictors of treatment response. In this multi-site R01 with Children's Hospital Colorado, the study investigators will conduct a 2-stage sequential, multiple assignment, randomized trial (SMART) to evaluate the effectiveness of our mHealth intervention strategies for improving adherence to daily inhaled corticosteroids in adolescents with asthma. Following a baseline period, adolescents will be randomized to a mHealth asthma management app (control group) or Asthma Ctrl, a text-messaging intervention providing adherence feedback based on adherence monitoring (treatment) for SMART Stage 1. Participants will be excluded from the study if they have an adherence that is >68%. For SMART Stage 2, adolescents randomized to the treatment group who demonstrate non-adherence (≤68% adherence; non-response) will undergo a second randomization to receive either 1) continued Asthma Ctrl (text messaging) or 2) Asthma Ctrl+ (Asthma Ctrl augmented with a problem-solving intervention delivered via telehealth). Thus, there are three intervention strategies that will be tested in this SMART: #1 control condition, #2 treatment, and #3 adapted treatment after Stage 2 and at follow-up (1 and 6 months). This innovative SMART design will address objectives described in the brief summary.

• Study Type: Interventional
• Enrollment (Estimated): 389
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Rachelle R Ramsey; Phone Number: 513-803-8348; Email: rachelle.ramsey@cchmc.org

Study Locations

• United States
  • Colorado
    • Aurora, Colorado, United States, 80262
      • University of Colorado AMC
      • Contact: Heather DeKeyser
      • Principal Investigator: Heather De Keyser
  • Ohio
    • Cincinnati, Ohio, United States, 45229
      • Cincinnati Children's Hospital Medical Center
      • Contact: Rachelle R Ramsey; Phone Number: 513-803-8348; Email: rachelle.ramsey@cchmc.org
      • Principal Investigator: Rachelle R Ramsey

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Patient age between 12-18 years
• Patient is diagnosed with severe-persistent or moderate-persistent asthma per NAEPP asthma guidelines
• Patient is prescribed at least one daily inhaled controller medication or a daily combination inhaled corticosteroid and long-acting beta-agonist and a beta-agonist bronchodilator
• English fluency for patient, caregiver, and clinician

Exclusion Criteria:

• Significant cognitive deficits that may interfere with comprehension per medical team or chart review
• Diagnosis of serious mental illness (e.g., schizophrenia)
• Diagnosis of pervasive developmental disorder
• Active chronic disease apart from asthma or allergic disease (e.g. Bronchiectasis, pulmonary hypertension, and moderate or severe tracheomalacia)
• Patient receives school administered daily controller medication at the time of the enrollment visit

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Sequential Assignment
• Masking: Single

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Control; Participants will receive access to an asthma management application providing education and automated reminders	Behavioral: Control; Asthma management application providing education and automated reminders
Experimental: Asthma Ctrl; Participants will receive the Asthma Ctrl intervention	Behavioral: Asthma Ctrl; Individualized adherence feedback via text messaging intervention based on real-time adherence monitoring
Experimental: Asthma Ctrl+; Participants will receive the Asthma Ctrl+ intervention	Behavioral: Asthma Ctrl+; Interventions described in Asthma Ctrl with problem-solving skills training via four telehealth sessions to occur every other week.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Electronically Monitored Controller Medication Adherence	Monthly adherence rates will be calculated by dividing the number of doses recorded by the electronic monitor by the total number of prescribed doses; the rate is then multiplied by 100 to determine the percentage. For patients prescribed Single Maintenance and Reliever Therapy, per the new asthma guidelines, the study investigators will assume that initial doses taken are for prevention and adherence will be capped at 100%.	12 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Composite Asthma Severity Index (CASI)	A weighted score comprised of: number of days with symptoms and albuterol use in past 2 weeks; number of nights with symptoms and albuterol use in past 2 weeks; Type/dose of controller medication; Exacerbations (i.e., prednisone burst, hospitalizations) in last 2 months The CASI score, ranging from 0 to 20 points, includes 5 domains: day symptoms and albuterol use, night symptoms and albuterol use, controller treatment, lung function measures, and exacerbations. The CASI is designed for children and adults ages 6 and older. A CASI score in the range of 0 to 3 indicates low severity. A CASI score greater than 3 may indicate medium to high asthma severity.	Baseline assessment and then once a month for 12 months
Asthma Control: Asthma Control Test (ACT)	Five-item adolescent self-report, 4-week recall of frequency of asthma symptoms, use of rescue medications, effect of asthma on daily functioning, perception of asthma control. Items are rated using a 5-point scale. The total score ranges from 5 to 25. A score of 19 or less indicates that asthma may not be well controlled, signaling the need for a review with a healthcare provide	Baseline assessment and then once a month for 12 months
Lung Function	Mobile spirometry to capture Forced Vital Capacity (FVC)	Baseline and then once a month for 12 months
Lung Function	Mobile Spirometry to capture Forced Expiratory Volume in 1 second (FEV1)	Baseline and then once a month for 12 months.
Lung Function	Mobile spirometry to capture Ration of Forced Expiratory Volume to Forced Vital Capacity (FEV1/FVC)	Baseline and then once a month for 12 months
Lung Function	Mobile Spirometry to capture Forced Expiratory Flow (FEF)	Baseline and then once a month for 12 months
Healthcare Utilization	Patients and caregivers will self-report the occurrence of asthma-related emergency department and urgent care visits, hospital admissions, and ICU admissions in the past month. Study staff will also review the patient's medical chart for the above information as well as asthma-intubation.	Baseline assessment and then once a month for 12 months.
Asthma Exacerbations	Adolescents will provide a two-week recall of their use of oral steroids to treat an exacerbation. Study staff will also review the medical chart for this information.	Baseline assessment and then once a month for 12 months.

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Demographic Questionnaire	Adolescents and caregivers will complete a questionnaire to collect information about demographics.	Baseline
Hardship questionnaire	Adolescents and caregivers will complete a 19-item validated questionnaire designed to capture current hardships.	Baseline assessment and then at 6 months and 12 months
Asthma Knowledge	Adolescents will complete a 13-item a questionnaire assessing the extent to which they agree with facts or information about asthma to provide a measure of health beliefs.	Baseline assessment and then at 6 months and 12 months
Adolescent Medication Barriers Scale (AMBS)	16 (adolescent) item report assessing perceived barriers to treatment adherence using a 5-point Likert scale from 1 ("strongly disagree") to 5 ("strongly agree"). Higher scores on the AMBS are linked to poorer adherence and increased medical complications.	Baseline assessment and then at 6 months and 12 months.

Collaborators and Investigators

• Sponsor: Children's Hospital Medical Center, Cincinnati
• Collaborators: National Heart, Lung, and Blood Institute (NHLBI)
• Investigators: Principal Investigator: Rachelle R Ramsey, Children's Hospital Medical Center, Cincinnati

Study record dates

Study Major Dates

• Study Start (Estimated): May 30, 2026
• Primary Completion (Estimated): January 1, 2030
• Study Completion (Estimated): June 1, 2030

Study Registration Dates

• First Submitted: March 26, 2026
• First Submitted That Met QC Criteria: April 1, 2026
• First Posted (Actual): April 6, 2026

Study Record Updates

• Last Update Posted (Actual): May 11, 2026
• Last Update Submitted That Met QC Criteria: May 8, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: adherence; asthma; adolescents; sequential, multiple assignment, randomized trial (SMART)
• Additional Relevant MeSH Terms: Immune System Diseases; Respiratory Tract Diseases; Lung Diseases; Bronchial Diseases; Lung Diseases, Obstructive; Respiratory Hypersensitivity; Hypersensitivity, Immediate; Hypersensitivity; Asthma
• Other Study ID Numbers: 2024-0434; 1R01HL172827-01A1 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: Sufficient data from this project will be preserved to enable sharing via BioLINCC. The study investigators will share summary data (a less detailed data table) with data that is of sufficient quality to validate and replicate research findings described in the Aims.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No