Struggling With Asthma? There's An App For That

Some illnesses are hard to ignore, with constant symptoms that become instant reminders when a medication dose is missed. Others, like asthma, can seem to disappear for a while, until they strike suddenly and severely, with potentially life-threatening results.

Medications can control symptoms, but when feeling well, anyone can forget to take doses, and that's when patients get into trouble. More than 6 million Americans have asthma, and every year hospital emergency rooms see 2 million visits for the condition - half from kids.

That works out to about one potentially devastating incident every 15 to 20 seconds, often triggered when someone with asthma comes into sudden contact with one of several different triggers -- like pollen or smoke -- when they least expect it.

There's an app for that
At Nationwide Children's Hospital, we have seen this happen far too often, but the problem is not so easily fixed.

My colleague Dr. Nabeel Farooqui came up with the idea for an app, one that could remind patients to take their meds and guide them when problems strike. It turns out he was not alone - there are a lot of apps for asthma sufferers, but not all can be trusted to help.

Our team decided to not only create an asthma app, but to run clinical studies to make sure it actually does what we want: change behavior and ultimately, reduce asthma attacks.

Before developing a product people will actually use, it makes sense to understand the problems those users will face. One of the biggest problems for asthma sufferers is getting a handle on medications, which are critical because they control the disease's two components. The first is inflammation and swelling inside the lower airways, which is present at all times, while the second is an acute phase - often triggered by irritants - that causes the airways to squeeze, tighten and twitch. That second effect, commonly recognized as an asthma attack, causes difficulty breathing and can progress to respiratory distress. In our current age of medical treatments, deaths from asthma occur every day, even in children.

For patients with chronic or severe symptoms, the inflammation is more severe and requires daily treatment in order to prevent the more urgent flare-ups. That means patients need daily reminders and access to information about changes in their condition. To try to answer all of those needs, we built AsthmaCare.

Data based, user guided
While one study found fewer than half of all asthma apps are built upon evidence based studies, and even fewer contained reliable information, AsthmaCare is based on current National Heart Lung Blood Institute asthma guidelines and clinical standards of care. Unlike many health care apps, ours was designed and developed by physicians, asthma experts who treat children with asthma every day. Users input the triggers that cause them the most trouble, medications, doses, symptoms as they occur, and whether they require a rescue inhaler or not.

The app organizes the data to send reminder alerts for trigger avoidance and to take medication, tracks symptoms and how well users follow their personalized action plans, and awards points to help track progress and provide ongoing reinforcement.

The action plan is particularly valuable, converting paper-based instructions into an electronic version immediately available on their handheld device that's simpler for each patient to follow. When symptoms occur, the plan guides the user on how best to deal with them, or if it may be time for the emergency room.

We also decided to include a way for users to send their regularly updated symptom diary to their email address or their doctor's, which is far better than relying on a patient's memory for gathering objective evidence to guide treatment. We were pretty confident we pulled together a fairly complete app.

Then we tested it.

Use it and they won't come
In our first study, a small pilot to test feasibility and acceptability, 23 adolescents used the app for 30 days. What we found was that all of the participants used it - that in itself is an accomplishment for this age group. Less surprising was that the users preferred the app to the standard forms of asthma management, like those written treatment plans they'd used since childhood.

All participants used the app on a daily basis, and almost all users accessed it multiple times each day. Participants also reported they would refer the app to friends who needed it.

Based on that early evaluation, we decided to do a longer prospective study that we're currently wrapping up. In this one, we recruited over 200 children of all ages who had visited our hospital's emergency department for an asthma attack. Half of the participants were treated with standard management whereas the other half were set up with AsthmaCare before going home.

We're going to follow these kids for six months, to see if our app can actually help keep the kids out of harm's way and improve their asthma management over the long term. Asthma can be frightening for parents, especially for younger children who can't always verbalize what they may be feeling. We believe the app can help with that, but ultimately the app is a tool, not a cure, and will never replace the important individualized care provided by a child's pediatrician or asthma specialist.

It's important for anybody with asthma to understand they can control their symptoms as long as they take necessary daily controller medications and have access to fast-acting reliever medications, such as albuterol. With a thorough plan in place, and the right incentives to follow it, patients can control their asthma, and hopefully not end up in the hospital when they least expect it.

Asthma Care is available through the Nationwide Children's Website at www.nationwidechildrens.org/asthmacare. Funded by a private donation from the Heffner Family Foundation, it's free for both iOS and Android.

David Stukus, MD
Pediatric Allergist/Immunologist
Nationwide Children's Hospital
@AllergyKidsDoc