Abstract
ObjectiveAdequate 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.MethodsThrough 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 TestTM (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.ResultsThirty 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.ConclusionsWeekly 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.
Highlights
Despite improved understanding and the development of new medications, asthma remains a substantial and costly public health problem [1]
National Asthma Education and Prevention Program and Global Initiative for Asthma clinical practice guidelines recommend doctors monitor whether treatment is controlling symptoms and improving quality of life [5,6]; physicians lack ways to objectively assess how well patients manage asthma symptoms between visits, and often underestimate the frequency and severity of patients’ symptoms [7]
Participant characteristics A total of 33 individuals were initially recruited for the study and 29 provided complete information on asthma control at entry
Summary
Despite improved understanding and the development of new medications, asthma remains a substantial and costly public health problem [1]. Questionnaires that capture composite asthma-control measures have become popular tools to help patients and their physicians determine level of control [7]. These questionnaires ask patients to recall and report over some period of time symptom frequency, activity level and restriction, and inhaler usage. Underlying these instruments is evidence that symptom frequency and bronchodilator use are important indicators of asthma control, of current impairment, and of future risk of worsening asthma [6,7]
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