Research
My Story
Asthma has always been an intriguing disease with no known cause and fix. As an intern for pulmonologist/pediatrician Dr. Monal Shah, I have the opportunity to visit a few of her pulmonary patients as well as potential ones. To manage asthma, she utilizes a written asthma action plan for her patients. I suddenly wondered in this tech-savvy world, is it plausible for patients to use apps to manage their asthma and how effective it is
What I Know
Before conducting my extensive research, I had a brief understanding of all the aspects of information I would be able to learn in the realm of asthma. I knew asthma is a chronic lung disease that inflames and narrows the airways in the lungs. Symptoms include coughing, shortness of breath, and chest tightness. I also had a basic understanding of how the medication was utilized due to familial experiences such as inhaled corticosteroids such as Flovent HFA and QvarRediHaler. But I did not know the behind the scenes of the identification process of asthma. I wanted to understand the tests which are required to confirm asthma.
The Search
I referred to multiple research reports and articles on the Internet for information on factors affecting an asthma action plan. The following are some of the critical resources I used:
Source 1: https://www.bmj.com/content/344/bmj.e1756
This journal’s goal was to determine whether mobile phone based monitoring improves asthma control compared with standard paper based monitoring strategies. Participants were centrally randomised to twice daily recording and mobile phone based transmission of symptoms, drug use, and peak flow with immediate feedback prompting action according to an agreed plan or paper based monitoring.There was no significant difference in the change in asthma control or self efficacy between the two groups .The numbers of patients who had acute exacerbations, steroid courses, and unscheduled consultations were similar in both groups, with similar healthcare costs. Overall, the mobile phone service was more expensive because of the expenses of telemonitoring. Mobile technology does not improve asthma control or increase self efficacy compared with paper based monitoring when both groups received clinical care to guidelines standards. The mobile technology was not cost effective.
There are 300 million people in this world suffering from a chronic disease known as asthma. There many ways to manage it but only 1 percent utilize asthma apps in todays tech savvy era. Research2Guidance’s analysis of the 2017 mobile health apps that target primarily asthma patients shows that the asthma market is yet to experience its breakthrough. Given the current asthma apps little impact on the digital solutions market and no asthma app dominating the market, the asthma app publishers must rethink their business concepts and service offerings. Continued quality improvement of the asthma apps to meet best in class standards for better user acquisition and retention, in addition to further improvement of digital health innovation competencies to offer more original and personalized mHealth solutions in relation to prevention, diagnosis, and treatment of asthma sufferers will have a high impact on the market. The opportunity is there to be taken and to play a key role in improving the quality of asthma sufferers’ lives.
Source 3: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3523082/
Apps have been enthusiastically adopted by the general public. They are increasingly recognized by policy-makers as a potential medium for supporting self-management of long-term conditions. The authors of the journals assessed the degree to which current smartphone and tablet apps for people with asthma offer content and tools of appropriate quality to support asthma self-management. They identified 103 apps for asthma in English, of which 56 were sources of information about the condition and 47 provided tools for the management of asthma. No apps offered both types of functionality. Only three information apps approached our definition of comprehensiveness of information about asthma. No apps provided advice on lay management of acute asthma that included details of appropriate reliever medication use. In 32 of 72 instances, apps made unequivocal recommendations about strategies for asthma control or prophylaxis that were unsupported by current evidence. Although 90% of apps stated a clear purpose, compliance with other best practice principles for health information was variable. Contact details were located for 55%, funding source for 18% and confidentiality policy for 17%.
What I Discovered
Asthma affects 300 million people in the world and individuals with asthma are increasingly turning to mobile health to help with asthma management. Mobile health, or mHealth, refers to mobile computing, medical sensor, and communications technologies that can enhance chronic disease care.
The number of medical apps has dramatically increased over the past decade. As of 2012, there were more than 13,000 healthcare-related apps available to Apple iPhone users and more than 6,000 available in the Android store according to Mobi Health News. It is becoming common for patients to ask their physicians to help them choose apps, but many physicians do not feel confident in recommending apps to patients. In this research project, I provide an overview of the effectiveness of asthma care apps.
The largest proportion of asthma-related apps focus on teaching and training in techniques related to managing asthma. Most of these apps teach users alternative methods for treating asthma, such as yoga postures, acupressure, and breathing exercises. Many apps provide general information about asthma through text, video, and audio formats. Other apps offer treatment information; for example, some demonstrate an inhaler technique. Some of the apps with child-friendly interfaces are designed to improve medication adherence and teach children how to manage their asthma through games or quizzes such as WellaPets or SPARX. Some of the apps are directed at health care providers rather than patients. Most apps in this category provide medical reference information, whereas others teach medical trainees lung sounds and general information about asthma and allergies. Approximately a small percent of apps offer users with air quality information such as AlleryAlert. Most of these apps allow users to enter their location, whereas the rest are directed at residents of a specific city.
However, inconsistencies were also seen in apps that offered tools. Peak flow and symptom diaries, although generally reliable, often lack basic features, such as data entry validation, and, consequently, no particular app stood out in this group. Peak flow calculators and questionnaire-based apps designed for use by people with asthma appear to be unreliable and should not be used. According to “Patient Self-Management of Asthma Using Mobile Health Applications: A Systematic Review of the Functionalities and Effects,” they were unable to identify the underlying calculation for most; numeric errors were present in those that they could verify, and only one attempted to compensate for differences in readings from different peak flow meter types.
Health professionals, particularly GPs with very limited consultation time, face broader issues in prescribing apps that function as self-management tools. Patients may need help addressing technical problems, such as installing an app or fixing it if it crashes. Apps that enable the creation of action plans or data collected into diaries require new ways of working to populate those records, review data and respond in a timely fashion. If data are being transferred from patient devices, clinicians must think about how those data will be integrated into patient records and their responsibilities for data security.
According to “Clinical and cost effectiveness of mobile phone supported self-monitoring of asthma: multicentre randomized controlled trial,” There was no significant difference in the change in asthma control in the two groups. Over half the patients in both groups improved by more than the minimum important difference. At six months, 29/139 (21%) of participants in the mobile group and 31/139 (22%) of the paper group had achieved the “well controlled” threshold of ACQ. Similarly, 69/139 (50%) of participants in the mobile group and 67/139 (48%) of the paper group still scored above the “poorly controlled” threshold of ACQ ≥1.50. This data displays that mobile asthma tools do not serve a significant role in the improvement of asthma management, yet it provides the same results as a written asthma action plan.
For providers to recommend apps to their patients, efficacy, and effectiveness evaluations are necessary; however, few such evaluations are currently available. A Cochrane review of smartphone and tablet self-management apps for asthma in 2013 found only two trials of phone-based asthma self-management interventions that included randomized controlled trials to assess for efficacy. The authors deemed the utility of apps to be inconclusive and were unable to advise clinicians and the general public on the efficacy of apps for asthma self-management. Studies that include diverse asthma patients and providers are designed to randomize interventions and measure helpful patient-centered, as well as clinically relevant; outcomes are needed to determine which apps are beneficial and should be recommended to patients.
In addition to requiring demonstrated clinical efficacy and providing scientifically sound advice, apps must also ensure data privacy and security before health care providers feel comfortable recommending them. The health visualization and tracking group of apps, for which individuals can enter personal data to monitor symptoms, log peak flow, and more, is the category most vulnerable for loss of privacy or possible unwanted disclosure of personal health information. A previous study that systematically assessed the availability of privacy statements for the most commonly used apps from “The Journal of the American Medical Informatics Association” found that only 30% had privacy statements that addressed whether entered information could be shared with third parties.
In conclusion, as the number of apps made available continues to increase, and agencies such as the FDA become involved in their regulation, the mHealth landscape will continue to change. Although apps have great potential to improve care for asthma, most are currently limited by their inability to demonstrate quality, effectiveness, and protection of user data.