Remote monitoring of inhaled bronchodilator use and weekly feedback about asthma management: an open-group, short-term pilot study of the impact on asthma control

David Van Sickle, Sheryl Magzamen, Shaun Truelove, Teresa Morrison, David Van Sickle, Sheryl Magzamen, Shaun Truelove, Teresa Morrison

Abstract

Objective: Adequate symptom control is a problem for many people with asthma. We asked whether weekly email reports on monitored use of inhaled, short-acting bronchodilators might improve scores on composite asthma-control measures.

Methods: Through an investigational electronic medication sensor attached to each participant's inhaler, we monitored 4 months' use of inhaled, short-acting bronchodilators. Participants completed surveys, including the Asthma Control Test(TM) (ACT), to assess asthma control at entry and monthly thereafter. After the first month, participants received weekly email reports for 3 months. The reports summarized inhaled bronchodilator use during the preceding week and provided suggestions derived from National Asthma Education and Prevention Program (NAEPP) guidelines. Paired t-tests and random-effects mixed models were implemented to assess changes in primary asthma endpoints.

Results: Thirty individuals participated in the 4-month study; 29 provided complete asthma control information. Mean age was 36.8 years (range: 19-74 years); 52% of respondents were female. Mean ACT scores were 17.6 (Standard Deviation [SD] = 3.35) at entry and 18.4 (SD = 3.60) at completion of the first month. No significant difference appeared between ACT values at entry and completion of the first month (p = 0.66); however, after participants began receiving email reports and online information about their inhaler use, mean ACT scores increased 1.40 points (95% CI: 0.61, 2.18) for each subsequent study month. Significant decreases occurred in 2-week histories of daytime symptoms (β = -1.35, 95% CI: -2.65, -0.04) and nighttime symptoms (β = -0.84, 95% CI: -1.25, -0.44); no significant change in activity limitation (β = -0.21, 95% CI: -0.69, 0.26) was observed. Participants reported increased awareness and understanding of asthma patterns, level of control, bronchodilator use (timing, location) and triggers, and improved preventive practices.

Conclusions: Weekly email reports and access to online charts summarizing remote monitoring of inhaled bronchodilator frequency and location were associated with improved asthma control and a decline in day-to-day asthma symptoms.

Conflict of interest statement

Competing Interests: The authors have read the journal's policy and have the following conflicts to report: DVS is a shareholder and officer in a company (Reciprocal Labs Corporation) that is developing an electronic inhaler sensor for commercial use. The company did not participate in this research study or finance this manuscript in any way. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials. The other authors declare that no competing interests exist.

Figures

Figure 1. GPS-enabled inhaler sensor as attached…
Figure 1. GPS-enabled inhaler sensor as attached to inhaled albuterol.

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