Ambulatory Management of Childhood Asthma Using a Novel Self-Management Application

To examine the effects of a home self-monitoring application (the electronic-AsthmaTracker, or e-AT) for children with asthma on quality of life (QoL), asthma control, and patient and caregiver productivity.

327 pediatric patients with persistent asthma followed at 11 ambulatory clinics owned by a regional not-for-profit integrated health care system were included in the study.

The e-AT, an asthma symptom tracker for children, was developed by a team of 6 parents and 7 community stakeholders on an electronic platform. From January 2014 to December 2015, children aged 2 to 17 years with National Institutes of Health–defined persistent asthma were recruited from the 11 participating clinics to adopt the e-AT, with a target sample size of 30 patients per clinic. Patients who adopted the e-AT recorded asthma symptoms weekly. In turn, patients, parents, and primary care providers received real-time alerts for early signs of impaired asthma control. QoL scores were measured at baseline, 3 months, 6 months, and 12 months. The patient’s rates of emergency department (ED) visit, hospital admission, and treatment with oral corticosteroid (OCS) were also measured for 1 year after e-AT initiation and analyzed against a control group of age-matched persistent asthma patients from 42 non-participating ambulatory clinics in the same health care system and geographic region.

318 patients and primary caregivers who adopted the e-AT completed baseline assessments and were included in the analysis. At 12 months from e-AT initiation, adherence with weekly use of the tracker was 65%. Self-monitoring with the e-AT was associated with an average increase in QoL score from 79.1 at baseline to 90.6 at 12 months, and an average increase in asthma control questionnaire (ACQ) score from 18.8 to 22.9 over the same time period. Among e-AT adoptees, ED and hospital admission rates were reduced by 59% over 12 months post-initiation, whereas no change was seen in controls. Notably, however, baseline admission rates were higher among cases than controls. A similar pattern was observed when OCS treatment, a surrogate for asthma control, was compared: patients who adopted e-AT showed a mean reduction of 35% in OCS treatment while no improvement was found in the control population. Finally, implementation of the e-AT was associated with improved school and work attendance from baseline to 12 months.

Despite relatively modest weekly adherence, pediatric asthma patients who initiated an electronic self-monitoring tool had improved quality of life, fewer visits to the ED or hospital, fewer courses of systemic steroid, and fewer days of lost productivity. The e-AT may represent a promising proactive management model for children with asthma and their caregivers.

Successful asthma management relies on understanding symptoms and continual monitoring. Traditionally, asthma control is assessed at periodic outpatient visits with such tools as the ACT score. The advent of the digital era has opened the door to personal health technologies, which in the case of an in-home symptom tracker enable more frequent self-evaluation. Self-monitoring allows providers to “fill in the gaps” of an asthmatic patient’s clinical course by generating more data points. It can also help avoid recall bias and may promote timely intervention when symptoms deteriorate. It is always fascinating to see how most randomized controlled asthma studies identify improvement in the control groups, largely attributed to frequent contact with study personnel and bringing asthma more to the forefront of people’s minds. The findings in this study demonstrate that adherence with any monitoring system will likely always be an issue, but for those patients amenable to mobile health applications, self-monitoring tools may be empowering and lead to positive outcomes.