New App Boosts Kids' Asthma Management

Marcia Frellick

May 16, 2019

An app called e-AT (for e-Asthma Tracker) helps physicians and families manage children's asthma, reducing severe attacks and keeping kids out of the hospital, results of a prospective cohort study show.

The app "has potential to broadly improve pediatric ambulatory asthma care," Flory L. Nkoy, MD, MS, MPH, of the Department of Pediatrics at the University of Utah in Salt Lake City, and colleagues write in a paper published online today in Pediatrics.

The app has several features to improve asthma management over time, including real-time graphing of results, alerts for children and parents, automatic notification of primary care providers when asthma control starts to worsen, and real-time recommendations for action with a color-coded system based on level of urgency.

The researchers enrolled children and a parent or caregiver through 11 clinics across Utah and Idaho, in a mix of urban and rural settings. To be eligible, the children had to be age 2 - 17 years, have persistent asthma, and need ongoing controller medication.

Each week, children or parents used the app to answer a short survey, based on a standard asthma control test, that asked how symptoms affected their daily activities. Based on those answers, the app generates a graphic of asthma activity and makes recommendations.

After 1 year of app use, 65% of the 327 participants were still using the app.

Compared with baseline, asthma control scores went up by about 4 points, twice the 2-point difference needed to be considered clinically important, the authors write.

Average number of school days interrupted or missed dropped significantly (P < .001) from 1.91 at baseline to 0.79, 0.52, and 0.79 at 3, 6, and 12 months, respectively. The average number of interrupted or missed parent work days also significantly decreased (P <.001) from 0.72 at baseline to 0.27, 0.25, and 0.20 at 3, 6, and 12 months.

When researchers compared results from 1 year before app use to 1 year after, they found fewer emergency department (ED) and hospital admissions (rate ratio [RR], 0.68; 95% confidence interval [CI], 0.49 - 0.95).

Those results were consistent when the comparison was matched with controls: Children using the app had 59% fewer ED and hospital admissions (RR, 0.41; 95% CI, 0.22 - 0.75).

In addition, oral corticosteroid use dropped from baseline (RR, 0.65; 95% CI, 0.46 - 0.93) and was 26% lower when compared with matched controls (RR, 0.74; 95% CI, 0.61 - 0.91).

Children also had significantly increased quality of life scores. (P < .001). The average score increased from 79.1 at baseline to 90.9, 90.0, and 90.6 at 3, 6, and 12 months, respectively.

"It's difficult to predict how active your asthma is unless you have an attack or flare-up," senior author Bryan Stone, MD, a pediatrician at University of Utah Health said in a press release. "e-AT allows doctors and patients to continuously monitor their disease and take control of it."

Nkoy told Medscape Medical News that the app is secure and HIPAA compliant and can be used on individual devices or integrated within a health system's electronic health record.

"It is readily available to be deployed to any health system or clinic, and for use by any patient in any location with internet access and a secure log-in," he said. "We are currently assessing a new deployment model through a health insurance plan, which will allow a large scale-up to many patients."

The Technology Transfer Department at the University of Utah can facilitate access to the app, he said.

The study was supported by a Patient-Centered Outcomes Research Institute (PCORI) grant. Nkoy and coauthors received salary and travel support and payment through PCORI. The authors have disclosed no relevant financial relationships.

Pediatrics. Published online May 16, 2019. Abstract

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