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.
Asthma is a common long-term inflammatory disease of the airways of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. Symptoms include episodes of wheezing, coughing, chest tightness, and shortness of breath. These episodes may occur a few times a day or a few times per week.
Depending on the person, they may become worse at night or with exercise. Asthma is thought to be caused by a combination of genetic and environmental factors . 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, "despite 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 be successful in trial settings, evidence of their implementation into everyday practice is limited.
"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 . "
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 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.
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. 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 at expanding 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. Participants were enrolled from various specialty and primary care clinics that comprise a large healthcare system (Dignity Health) in the southwestern United States.