Children with asthma who use a web- and mobile–web-based self-management tool show high and sustained self-monitoring and improved asthma outcomes, a study in asthmatic children showed. The 2- to 17-year-old participants, whose persistent asthma was being managed at a pediatric ambulatory clinic, were matched with controls during the 1-year study period. Investigators compared outcomes in these weekly users of an electronic-AsthmaTracker (e-AT) with their own baselines as well as with outcomes in the controls—asthmatics who were receiving usual care at the study’s participating clinics.
The e-AT is based on the asthma control test, modified for weekly assessment, and coupled with decision support for proactive care. It features automated reminders to continue self-monitoring, graphing of real-time results, alerts for patients, parents, and the physician’s office (via e-mail or text) for early signs of asthma control deterioration, and real-time recommendations. The e-AT also records and promotes adherence by generating a congratulatory message and a $10 gift certificate every time 4 assessments are completed.
Of the 327 children and parents enrolled in the trial of e-AT, 65% had maintained adherence at 12 months. Compared with baseline, participants had significantly increased quality of life, asthma control, and had fewer reduced, interrupted, and missed school and workdays at all quarterly assessments. Compared with 1 year before the intervention, they had fewer emergency department (ED) and hospital admissions and less oral corticosteroid (OCS) use.
Compared with controls, participants also had reduced ED and hospital admissions and OCS use. Parents remained satisfied with the e-AT throughout the trial (Nkoy FL, et al. Pediatrics. 2019;143:e20181711).
Thoughts from Dr. Burke
The authors report that more than 8 million children in the United States have asthma and that 54% of them had an asthma exacerbation in 2016. Data from 2008 showed that asthma was responsible for 10 million missed school days and 14 million missed parent workdays that year. Imagine the impact if this program (with a 32% to 59% reduction in ED visits and hospitalizations and a 26% to 35% reduction in the need for oral steroid use) was implemented across the country. This innovative approach is worth a careful look. You can check out the e-AT at https://asthmatracker.utah.edu/public/index.php.