Modern medical science has made remarkable progress in the treatment of asthma. Inhalers Containing Steroids are particularly effective in preventing an asthma attack. But getting people to take these preventative drugs for a long time remains a challenge.
Because asthma is a persistent condition, many people find it difficult to take their medication regularly due to busy schedules or because the medication may not seem to work right away†
One potential solution lies in digital technologies that can reduce the risks associated with not taking medications as prescribed. These technologies include SMS reminders, web-based apps, interactive voice response systems and smart inhalers.
The benefits can be significant, as asthma is one of the most common health problems. It affects as much as 339 million people worldwide† New Zealand has one of the highest rates of asthma, with one in seven children and one in eight adults diagnosed†
Asthma attacks are also the most common cause of days off from school and work for people with the condition. In the UK it is estimated someone has a potentially life-threatening asthma attack every ten seconds, with comparable data in New Zealand. Asthma mortality is highest for Māori and Pacific peopleswith rates 4.3 and 3.2 times higher than for other groups.
While there are inhalers that work well for immediate symptoms, preventative medications are essential for long-term asthma control. These should be taken as directed, often once or twice a day. What is known as “non-compliance” with such regimens is a major health problem and can lead to increased symptoms and seizures.
Medication adherence strategies
Achieving adherence is therefore very important to reduce the risk of death. With increasing investment in digital technologies designed to improve health, the research focus with asthma is on improving the way existing drugs are used and thus improving outcomes.
Research in New Zealand has shown “smart” inhalers – devices that monitor when doses are taken and can provide reminders and feedback – improved adherence by 50% and improved control in children with asthma.
But we still don’t know whether digital technologies in general can improve the situation for all people with asthma and, even if they do, whether it will have a positive effect on asthma symptoms or attacks.
To learn more, we looked at all randomized controlled trials of digital technologies and their impact on asthma treatment adherence. We found 40 studies around the world, with a collective sample of more than 15,000 adults and children with asthma.
By pooling the data from all separate studies, we were able to measure whether people who used digital technologies to improve their medication regimen had better adherence — and fewer asthma symptoms and attacks — than those who didn’t.
How digital technologies can help
In a nutshell, digital technologies can work to improve the use of asthma medications.
On average, 15% more people took their medication as prescribed when they had the technology, compared to those who didn’t (who took 45% of the prescribed amount of their medication).
This 15% increase could have significant implications for people’s asthma treatment, as more regular medication use can reduce symptoms and reduce the risk of seizures.
Looking at all the studies, people with access to the digital technology had fewer asthma symptoms and, on average, half the risk of asthma attacks compared to people who didn’t get the technology. These benefits may reduce the risk of asthma-related deaths.
We also found that people who had the technology had better quality of life and lung function, although the effect on lung function was small and potentially of limited clinical importance.
Daily Asthma Care
For people with asthma who find it difficult to take their medication regularly, digital technologies are likely to help improve their medication use, which in turn can reduce asthma symptoms and attacks.
But we need more research on how to integrate these technologies into routine asthma care. The available studies do not tell us enough about the effects on leisure time at work or school, the cost-benefit ratio and whether there are harmful effects.
Also, digital technologies may not work for everyone. While research shows that users generally accept the technologies, people didn’t actually complete the full study in about 25% of the studies we examined.
Some technologies may also work better than others. We found that smart inhalers and texting systems seemed better at improving drug intake than other types of technology. But the small number of studies means we can’t be completely sure that these technologies definitely work better.
Future technical potential
Digital technologies are constantly evolving and are likely to play an even greater role in future asthma care. Devices such as smart watches can monitor changes in a person’s physiology in real time.
These changes can be used to predict a change in a person’s risk of asthma attacks when combined with information from the environment, such as changes in air temperature and humidity.
If proven to work, we could see a substantial change in the way asthma is treated. One day, users may be able to track their asthma control status simply by looking at their phones.
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