How can digital health solutions improve respiratory care?

Introduction

Over recent years, advances in digital technology, both in terms of capability and availability, have led to the emergence of numerous novel digital health solutions in respiratory care. Whilst the evidence for the effectiveness of such solutions may sometimes be lacking, and further evidence-based research is certainly required, exciting, new digital solutions have the potential to dramatically change the respiratory care landscape for the better.

How can novel digital health solutions improve diagnosis?

• Telehealth systems that use portable spirometry and mHealth apps to provide healthcare providers (HCPs) with relevant data have the potential to aid in remote diagnosis of asthma and COPD¹
• Portable spirometry data, together with details of patient history, may improve the accuracy of diagnosis, support tailored patient education and improve self-management²

How can novel digital health solutions improve disease control?

• Telehealth techniques, such as individually tailored text messaging, have been shown to improve asthma disease control in randomised controlled trial settings³
• Inhaler monitoring devices may improve patient asthma control and reduce rescue medication use⁴
• Remote monitoring of patients through telehealth techniques increases the amount of data available to HCPs,⁵ which could aid in the identification and treatment of patients whose disease is uncontrolled

How can novel digital health solutions improve adherence?

• Remote contact with HCPs through Telehealth (particularly using mHealth apps and video-based appointments) could improve patient disease awareness and adherence^6,7
• Inhaler monitoring devices have improved adherence and inhaler technique in some randomised controlled trials^4,8

How can novel digital health solutions predict and prevent exacerbations?

• Some mHealth apps can display environmental information. Used with patient spirometry data, this information has the potential to predict or prevent an asthma trigger¹⁰
• Telehealth systems assessed in randomised controlled trials, such as monitoring devices and mHealth applications, have been associated with lower rates of asthma-related hospitalisations and emergency department visits due to exacerbations⁹

Glossary

Telehealth

Telehealth describes technology that allows HCPs to communicate with patients at a distance.¹¹ It is a broad term, which includes the use of phone calls, video calls, text messages and smartphone/tablet applications.

Potential advantages over conventional appointments:

• Telehealth may improve convenience and reduce costs for patients⁵
• Telehealth could also increase efficiency for HCPs, by improving clinic congestion and reducing unneeded referrals⁵
• Remote monitoring of patients through telehealth techniques increases the amount of data available to HCPs⁵
• Telehealth techniques used in randomised controlled trials, often in conjunction with existing healthcare systems, have been shown to increase patient awareness and may encourage self-management of their disease¹¹

Portable spirometry

Digital, portable spirometry devices allow patients to test and monitor their spirometry at home. They are low cost, easy to use and produce results similar to that of conventional spirometry.

Some handheld spirometers, such as the AirNext, are controlled via a smartphone app, which allows the patient to make sure their lung function does not deteriorate. The results can easily be shared with a patient’s HCP, allowing the HCP to make informed decisions about a patient’s treatment.¹²

Mobile Health (mHealth) applications

The term mHealth refers to mobile health applications, which can be downloaded to smartphones, tablets or similar devices, that aim to improve patients’ health management. In respiratory care, mHealth applications can provide patients with further education about their disease, alert patients to changes in their environment or disease management, and collect and track relevant data that can easily be shared with HCPs.^10,13,14 Early studies suggest that patients with asthma using mHealth apps had better asthma control and treatment adherence, reduced rates of exacerbation and hospital admissions, and improved clinical outcomes and quality of life, compared with conventional interventions.^10,15,16

Inhaler monitoring devices

Inhaler monitoring devices can be used for both controller and reliever inhalers; they are either built into the inhaler or attached to the device separately. Depending on the model, they can track when and where an inhaler has been used, confirm if the complete dose has been inhaled and even provide reminders if a dose has been missed. They are designed to improve inhaler technique, increase adherence and optimize compliance.^7,11

• Capture real data such as symptoms to help HCPs make informed decisions about a patient’s treatment
• Confirm a drug has been inhaled
• Potentially increase patient motivation and involvement in their own disease management.

References

1. Gurbeta L, Badnjevic A, Maksimovic M, Omanovic-Miklicanin E, Sejdic E. A telehealth system for automated diagnosis of asthma and chronical obstructive pulmonary disease. J Am Med Inform Assoc 2018;25:1213–7.
2. Maria Matricardi P, Dramburg S, Alvarez-Perea A, et al. The role of mobile health technologies in allergy care: An EAACI position paper. Allergy. 2019;doi: 10.1111/all.13953. [Epub ahead of print].
3. Chongmelaxme B, Lee S, Dhippayom T, et al. The Effects of Telemedicine on Asthma Control and Patients’ Quality of Life in Adults: A Systematic Review and Meta-analysis. J Allergy Clin Immunol Pract 2019;7:199–216
4. Barrett MA, Humblet O, Marcus JE, et al. Effect of a mobile health, sensor-driven asthma management platform on asthma control. Ann Allergy Asthma Immunol 2017;119:415–21.e1
5. Wu AC, Rehman N, Portnoy J. The Good, the Bad, and the Unknown of Telemedicine in Asthma and Allergy Practice. J Allergy Clin Immunol Pract 2019;7:2580–2582.
6. Jeminiwa R, Hohmann L, Qian J, et al. Impact of eHealth on medication adherence among patients with asthma: a systematic review and meta-analysis. Resp Med 2019;149:59–68.
7. Lin NY, Ramsey RR, Miller JL, et al. Telehealth delivery of adherence and medication management system improves outcomes in inner‐city children with asthma. Pediatr Pulmonol 2020;55:858–65
8. Chan AH, Stewart AW, Harrison J, et al. The effect of an electronic monitoring device with audiovisual reminder function on adherence to inhaled corticosteroids and school attendance in children with asthma: a randomised controlled trial. Lancet Respir Med 2015;3:210–9
9. McLean S, Nurmatov U, Liu JL, et al. Telehealthcare for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2011;7:CD007718.
10. Asthma UK. Connected asthma: how technology will transform care. Available from: https://www.asthma.org.uk/f29019fc/globalassets/get-involved/external-affairs-campaigns/publications/connected-asthma/connected-asthma---aug-2016.pdf
11. Morrison D, Mair FS, Yardley L. et al. Living with asthma and chronic obstructive airways disease: Using technology to support self-management – an overview. Chron Respir Dis. 2017;14:407–419
12. Ramos Hernández C, Núñez Fernández M, Pallares Sanmartín A, et al. Validation of the portable Air-Smart spirometer. PLoS One. 2018;13:e0192789.
13. Howard S, Lang A, Sharmples S, et al. What are the pros and cons of electronically monitoring inhaler use in asthma? A multistakeholder perspective. BMJ Open Resp Res. 2016;3:e000159.
14. Williams V, Price J, Hardinge M, et al. Using a mobile health application to support self-management in COPD: a qualitative study. Brit J Gen Pract. 2014;64 e392–e400.
15. Farzandipour M, Nabovati E, Sharif R, et al. Patient self-management of asthma using mobile health applications: a systematic review of the functionalities and effects. App Clin Inform. 2017;8:1068–81
16. Xiao Q, Wang J, Chiang V, et al. Effectiveness of mHealth interventions for asthma self-management: a systematic review and meta-analysis. Stud Health Technol Inform. 2018;280:144–5.