A clinical trial has aimed to find out if using digital tools could help patients with uncontrolled asthma. The trial took place across ten different asthma clinics in Ireland, Northern Ireland, and England. The researchers compared two groups of patients, one group received treatment decisions based on data gathered from digital tools, while the other group received standard care.
The trial included patients who were 18 years or older and had uncontrolled asthma, despite taking high doses of inhaled corticosteroids. They also had at least one severe asthma attack in the past year. The patients were randomly assigned to one of the two groups. The first group received treatment decisions based on digital data on inhaler adherence, peak flow, patient-reported asthma control, and exacerbation history. The second group received treatment decisions based on pharmacy refill rates, asthma control by ACT(Asthma Control Test) questionnaire, history of exacerbations, and visual management of inhaler technique.
Both groups were given education visits and treatment adjustment visits with their doctors. The visits included three nurse-led education visits over 8 weeks and three physician-led treatment adjustment visits at weeks 8, 20, and 32. Both groups also used a digitally enabled Inhaler Compliance Assessment (INCA) and Peak Expiratory Flow (PEF) to monitor their asthma.
The primary outcomes of the trial were asthma medication burden and adherence rate. The researchers found that 14% of the group that received treatment decisions based on digital data required a net increase in treatment compared to 32% of the group that received standard care. The group that received treatment decisions based on digital data also had a lower rate of patients requiring add-on biological therapy. Patients in the digital data group were also less likely to increase their medication from fluticasone propionate 500 μg daily to 1000 μg daily. However, they were more likely to reduce their medication from fluticasone propionate 1000 μg once daily to 500 μg once daily.
The trial also found that the group that received treatment decisions based on digital data had a higher adherence rate compared to the group that received standard care. The actual mean adherence rate was 64.9% in the digital data group and 55.5% in the standard care group.
The trial had a total of 29 serious adverse events, 16 in the digital data group, and 13 in the standard care group. However, none of the events were causally linked to the trial intervention, to the use of salmeterol–fluticasone inhalers, or to the use of the digital PEF or INCA.
The clinical trial found that using digital tools to inform treatment decisions for patients with uncontrolled asthma can lead to a modest improvement in medication adherence and a significantly lower treatment burden. This means that using digital tools can help patients with uncontrolled asthma receive better care and potentially improve their quality of life. However, more research is needed to fully understand the benefits and limitations of using digital tools in the management of asthma.