A study in children with asthma showed that a medical and behavioral intervention program delivered by video-based telehealth (VBT) is feasible and can significantly improve asthma outcomes and care.
The 21 participants, who ranged in age from 10 to 17 years and were from economically disadvantaged neighborhoods, experienced uncontrolled asthma during the preceding 12 months, as evidenced by scores on the Asthma Control Test (ACT), hospital visits or admissions, and corticosteroid bursts.
During the 6-month study period, participants attended 7 VBT medical visits conducted by a pediatric pulmonologist or allergist. An asthma specialist determined needed level of asthma control and medication based on a physical exam with an electronic stethoscope, ACT scores, the Asthma TreatSmart program (a computer-based decision support tool), modified Composite Asthma Severity Index (CASI) scores, and electronic inhaler monitor data. The intervention also included 5 VBT school-based self-management visits with an adherence psychologist, who reviewed electronically monitored adherence data and identified and discussed barriers to adherence, helping to develop strategies to overcome them.
At the end of the study period, participants with higher baseline severity scores (CASI ≥4 at the first visit) had a greater reduction in CASI score than those with lower baseline scores (CASI <4 at the first visit), with improvements seen in daytime and nighttime symptoms and exacerbations. Adherence also improved, with 8 participants showing an adherence increase of more than 20% (Lin NY, et al. Pediatr Pulmonol. 2020;55:858-865).
Thoughts from Dr. Farber
Telemedicine holds great promise for many chronic conditions, among which asthma is prominent. I expect this program would work even without the electronic stethoscope because in long-term care, history of the illness and education of the family are more important than examination. Look for this field to expand rapidly in the near future.