Asthma Control and Medication Adherence: Time for a Digital Intervention
Information collected by electronic medication monitors can support self-management and personalized treatment in patients with asthma.
Although inhaled corticosteroids (ICS) are well-established as the cornerstone of asthma treatment, patient adherence has been consistently shown to be suboptimal. In a 2015 systematic review published in Respiratory Care, the mean level of ICS adherence ranged from 22% to 63% across the studies included, and poor adherence led to 24% and 60% of exacerbations and asthma-related hospitalizations, respectively.1
In most of the studies reviewed, focused interventions were associated with improved adherence. In recent years, there has been increasing interest in the use of digital interventions to achieve this outcome. However, "[d]espite evidence of benefits, guided self-management, particularly through the use of asthma plans, remains underused," the authors of a 2014 systematic review wrote. "While interventions can often be successful in trial settings, evidence of their implementation into every day practice is limited."2
"Therefore, there is growing interest in the potential of the Internet and other digital media as a medium to deliver more tailored, relevant self-management support, while maintaining cost-effectiveness, with greater scope for integration into the everyday lives of those with asthma."2
Effect of Digital Interventions
Such strategies, which include web-based programs, mobile apps, text messaging, and more, have been found to improve asthma control and ICS adherence while reducing the use of short-acting beta-agonist (SABA) "rescue" medications. The 2014 review reported that most digital interventions were linked to improved medication use, quality of life, and self-care.2
Furthermore, a pilot study published in 2017 in the Annals of Allergy, Asthma & Immunology examined the use of electronic medication monitors (EMMs) to record the frequency, location, and time of patients' SABA use.3 The results demonstrated improved asthma control, reduced SABA use, and a greater number of symptom-free days with EMM utilization.
A recent single-group study aimed to expand on those findings by investigating the effects of EMM use on the number of asthma-related hospitalizations and emergency department visits in 224 patients (57% female; mean age, 33 years) with asthma.4 Participants were enrolled from various specialty and primary care clinics that comprise a large healthcare system (Dignity Health) in the southwestern United States.
The participants were given EMMs that "tracked rescue and controller inhaler medication use, and a digital health platform that presented medication use information and asthma control status to patients and providers," as described in the article. "Patients authorized their [healthcare providers] to view their reports through a web interface, enabling them to integrate real-time information on SABA use and controller adherence into clinical decision-making."4