Smartphone and tablet self management apps for asthma
Open accessAbstract
BACKGROUND: Asthma is one of the most common long-term conditions worldwide, which places considerable pressure on patients, communities and health systems. The major international clinical guidelines now recommend the inclusion of self management programmes in the routine management of patients with asthma. These programmes have been associated with improved outcomes in patients with asthma. However, the implementation of self management programmes in clinical practice, and their uptake by patients, is still poor. Recent developments in mobile technology, such as smartphone and tablet computer apps, could help develop a platform for the delivery of self management interventions that are highly customisable, low-cost and easily accessible. OBJECTIVES: To assess the effectiveness, cost-effectiveness and feasibility of using smartphone and tablet apps to facilitate the self management of individuals with asthma. SEARCH METHODS: We searched the Cochrane Airways Group Register (CAGR), the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, CINAHL, Global Health Library, Compendex/Inspec/Referex, IEEEXplore, ACM Digital Library, CiteSeer(x) and CAB abstracts via Web of Knowledge. We also searched registers of current and ongoing trials and the grey literature. We checked the reference lists of all primary studies and review articles for additional references. We searched for studies published from 2000 onwards. The latest search was run in June 2013. SELECTION CRITERIA: We included parallel randomised controlled trials (RCTs) that compared self management interventions for patients with clinician-diagnosed asthma delivered via smartphone apps to self management interventions delivered via traditional methods (e.g. paper-based asthma diaries). DATA COLLECTION AND ANALYSIS: We used standard methods expected by the Cochrane Collaboration. Our primary outcomes were symptom scores; frequency of healthcare visits due to asthma exacerbations or complications and health-related quality of life. MAIN RESULTS: We included two RCTs with a total of 408 participants. We found no cluster RCTs, controlled before and after studies or interrupted time series studies that met the inclusion criteria for this systematic review. Both RCTs evaluated the effect of a mobile phone-based asthma self management intervention on asthma control by comparing it to traditional, paper-based asthma self management. One study allowed participants to keep daily entries of their asthma symptoms, asthma medication usage, peak flow readings and peak flow variability on their mobile phone, from which their level of asthma control was calculated remotely and displayed together with the corresponding asthma self management recommendations. In the other study, participants recorded the same readings twice daily, and they received immediate self management feedback in the form of a three-colour traffic light display on their phones. Participants falling into the amber zone of their action plan twice, or into the red zone once, received a phone call from an asthma nurse who enquired about the reasons for their uncontrolled asthma.We did not conduct a meta-analysis of the data extracted due to the considerable degree of heterogeneity between these studies. Instead we adopted a narrative synthesis approach. Overall, the results were inconclusive and we judged the evidence to have a GRADE rating of low quality because further evidence is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. In addition, there was not enough information in one of the included studies to assess the risk of bias for the majority of the domains. Although the other included study was methodologically rigorous, it was not possible to blind participants or personnel in the study. Moreover, there are concerns in both studies in relation to attrition bias and other sources of bias.One study showed that the use of a smartphone app for the delivery of an asthma self management programme had no statistically significant effect on asthma symptom scores (mean difference (MD) 0.01, 95% confidence interval (CI) -0.23 to 0.25), asthma-related quality of life (MD of mean scores 0.02, 95% CI -0.35 to 0.39), unscheduled visits to the emergency department (OR 7.20, 95% CI 0.37 to 140.76) or frequency of hospital admissions (odds ratio (OR) 3.07, 95% CI 0.32 to 29.83). The other included study found that the use of a smartphone app resulted in higher asthma-related quality of life scores at six-month follow-up (MD 5.50, 95% CI 1.48 to 9.52 for the physical component score of the SF-12 questionnaire; MD 6.00, 95% CI 2.51 to 9.49 for the mental component score of the SF-12 questionnaire), improved lung function (PEFR) at four (MD 27.80, 95% CI 4.51 to 51.09), five (MD 31.40, 95% CI 8.51 to 54.29) and six months (MD 39.20, 95% CI 16.58 to 61.82), and reduced visits to the emergency department due to a
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Eight reviews assessed the impact on asthma control through symptom scores, quality of life, or unscheduled health care.
“A total of 8 reviews assessed the impact on asthma control through symptom scores, quality of life, or unscheduled health care [20,24,27,28,36,61-63].”
de Jongh et al and Marcano Belisario et al reviewed mobile interventions and smartphone apps, respectively; the number of included RCTs was small for both (1 and 2).
“de Jongh et al [24] and Marcano Belisario et al [62] reviewed mobile interventions and smartphone apps, respectively. The number of included RCTs was small for both (1 and 2, respectively).”
The highest weighted asthma reviews each scored 2 stars, including three narrative syntheses and one meta-analysis.
“The highest weighted of these each scored 2 stars [24,27,62,63], including 3 narrative syntheses and 1 meta-analysis.”
Both de Jongh et al and Marcano Belisario et al highlighted the potential benefit from some positive findings in the studies but acknowledged that these findings were not consistent and that the evidence base required development.
“Both highlighted the potential benefit from some positive findings in the studies but acknowledged that these findings were not consistent and that the evidence base required development.”
Findings for monitoring and feedback in asthma and COPD were mostly neutral or inconsistent.
“This was the most commonly described telehealth component in the included systematic reviews and was associated with improved clinical outcomes in diabetes and heart failure [33,35,36,38,42,44,54,58]; however, findings for asthma and COPD were mostly neutral or inconsistent [61-63,65,66,68,69].”
Analyses of more specific, self-management-focused interventions for asthma and COPD showed insufficient or inconsistent evidence of benefit.
“analyses of more specific, self-management-focused interventions showed insufficient or inconsistent evidence of benefit [27,62].”
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- Authors
- Marcano Belisario, J. S., Huckvale, K., Greenfield, G., Car, J., & Gunn, L. H.
- Affiliations
- School of Public Health, Imperial College London; Global eHealth Unit, Department of Primary Care and Public Health; London UK
- Imperial College London (GB)
- University of Ljubljana (SI)
- Stetson University (US)
- Venue
- Cochrane Database of Systematic Reviews
- Publisher
- Wiley
- Published
- 2013-11-27
- Volume
- 2013
- Issue
- 11
- Pages
- CD010013-CD010013
- ISSN
- 1361-6137 (ISSN-L)
- 1465-1858
- PMC
- PMC6486323
- OpenAlex
- W1480140759
- Cited by
- 288
- References
- 78
- Citations by year
- 2026: 2 · 2025: 10 · 2024: 14 · 2023: 20 · 2022: 17 · 2021: 18 · 2020: 34 · 2019: 36 · 2018: 30 · 2017: 31 · 2016: 29 · 2015: 36 · 2014: 10 · 2013: 1
- FWCI
- 3.05
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Cochrane Database of Systematic Reviews (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Open Research (University of Surrey) (submittedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- asthma, self-management, mobile health apps, mobile application, tablet application, asthma control, asthma exacerbations, health-related quality of life, peak expiratory flow, asthma diary, cost-effectiveness, feasibility, chronic disease, patient education, medication adherence, symptom monitoring, remote monitoring, clinical implementation
- MeSH terms
- Asthma, Humans, Self Care, Randomized Controlled Trials as Topic, Computers, Handheld, Cell Phone, Mobile Applications
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