A new clinical trial found that using a smartphone app to monitor asthma symptoms between clinic visits led to a small but statistically significant improvement in patient-reported quality of life.
Published in JAMA Network Open, the study included 413 adults across seven primary care clinics that are affiliated with Brigham and Women’s Hospital in Boston. Participants were randomly assigned to either an intervention group in which they used the app, or a usual care group in which they received standard asthma guidance.
The app prompted weekly symptom questionnaires and allowed users to track triggers, view educational content, and request nurse callbacks if symptoms worsened. All data were integrated into the patients' electronic health records and shared with care teams.
Researchers assessed changes in the Mini Asthma Quality of Life Questionnaire (MiniAQLQ) over 12 months. On the questionnaire's 1 to 7 scale, a 0.5-point improvement is considered clinically meaningful. The intervention group saw an average increase of 0.34 points (95% confidence interval [CI] = 0.19–0.49), compared with 0.11 points (95% CI = –0.11 to 0.33) in the usual care group. The adjusted difference was 0.23 points (95% CI = 0.06–0.40; P = .01).
“Although the difference was statistically significant, it did not reach the threshold for a minimally important change,” wrote Robert S. Rudin of the Health Care Division at RAND in Boston, Massachusetts, with colleagues.
The researchers also evaluated whether the app reduced asthma-related emergency or urgent care visits and hospitalizations. Patients in the intervention group averaged 0.59 events per year, compared with 0.76 in the control group. This difference was not statistically significant (adjusted effect size = –0.16; 95% CI = –0.42 to 0.17; P = .23).
Subgroup analyses showed greater gains among younger adults (aged 18 to 44), who had an adjusted difference of 0.40 points (95% CI = 0.13–0.66), and among those with low baseline self-management scores, who improved by 0.77 points (95% CI = 0.30–1.24).
Improvements were also more pronounced in specific MiniAQLQ subdomains, particularly environmental stimuli, emotional function, and symptoms. No significant changes were found in the activity limitations domain.
Of the 413 patients enrolled, 366 (88.6%) completed the 12-month follow-up. Interestingly, patients with lower adherence or retention reported greater MiniAQLQ score increases than those with consistent app use.
The researchers concluded that while the average improvement in asthma quality of life was modest, digital symptom monitoring may benefit patients with poor baseline control or limited self-management capabilities.
Author disclosures are available in the published article. The trial was funded by the Agency for Healthcare Research and Quality and registered under ClinicalTrials.gov (NCT04401332).
Source: JAMA Network Open