Improvement in Asthma Control Using a Minimally Burdensome and Proactive Smartphone Application

Abstract

Background: Integrated chronic disease treatment models that enable patient self-care and shared treatment decision making have recently been shown to improve medication adherence and outcomes. Smartphone applications (apps) are a readily available means to enable this model, although sustained user engagement remains a challenge.

Objective: To assess the efficacy of improving asthma control using a proactive smartphone app without required regular inputs.

Methods: We designed a minimally intrusive smartphone app to provide individualized and timely support to patients with asthma based on the National Asthma Education and Prevention Program guidelines and Scripps management pathways. In this proof-of-concept study, we enrolled 60 adults with poorly controlled asthma to test the usability and effectiveness of this app over a 4-month period. The Asthma Control Test survey was used to assess control before, during, and after app use. As a corollary, a retrospective chart review was also used to assess changes in lung function and prescribed courses of systemic corticosteroids.

Results: Our patients, with a mean age of 50 years, reported an improvement in Asthma Control Test scores from 16.6 (inadequate to poor) to 20.5 (controlled) over the study period. Concurrently, there was a 7.9% absolute increase in FEV1, while courses of systemic corticosteroids decreased from 0.5 to 0.3 courses per 6-month period. Fifty-eight of 60 patients completed the final survey, with high satisfaction reported.

Conclusions: This app improved asthma control in a cohort of patients with uncontrolled asthma (age range, 17-82 years), while minimizing burdensome inputs and proactively providing individualized teaching and treatment support. The app and treatment model are scalable to cost-effectively manage chronic disease.

Keywords: App; Asthma; Mobile health; Self-care; Smartphone application.

Conflict of interest statement

Conflicts of interest: K. A. Cook declares no relevant conflicts of interest.

Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Figures

FIGURE 1

Screenshots demonstrating user engagement and self-assessment functionality. A, Embedded videos and accompanying text provide a user-friendly experience. B, Proactive alerts appear on the home screen and prompt the patient to actively engage in self-care and self-assessment. C, Assessment of asthma control is made using the ACT survey, with results reported as red, yellow, or green. Individualized coaching is provided on the basis of entries (Figure 2).

FIGURE 2

Screenshots demonstrating individualized coaching. “Coaching” is provided on the basis of recorded patient entries and inquiries as well as assessment of knowledge regarding asthma self-care. Patient data are continually collected and analyzed by the app to provide personalized content. Personalized content may include (A) discussions of triggers, (B) strategies to improve medication adherence such as coordinating with daily activities (dishwashing, showering, etc), and (C) overview of inhaler technique among other topics relevant to effective self-care.

FIGURE 3

Distribution of ACTscores throughout the study period. A, ACTscore distribution for all patients is depicted, with notable trend toward well-controlled asthma. B, ACTscore distribution of patients beginning in the red or yellow zone is depicted; 72% of these patients achieved a final ACT score of 20 or more despite “poorly controlled” or “not well controlled” asthma at the time of study enrollment. *Key: Green, >19; yellow, =16–19; red, <16.

FIGURE 4

Mean ACTscores throughout the study period. ACTscores with 95% CIs are represented, with a consistent positive trend. A mean increase of 3.9 and 5.7 (both P <.05) points was noted across all patients and those beginning the study with an ACTscore of 19 or less, respectively.

FIGURE 5

Patient satisfaction and user engagement. After 4 months of using Scripps Asthma Coach, patients were asked to rate their level of agreement or disagreement with various aspects of their experience with the app. Fifty-eight of 60 patients completed the survey. Responses indicated that patients found the app easy-to-use, personalized, and helpful in managing their asthma. 95% CIs are included.