A smartphone-based asthma management program significantly enhanced symptom control, but may require engagement or cultural tailoring to expand the effect.
In a diverse group of US adults with uncontrolled asthma, a year-long randomized clinical trial evaluating a smart-phone based digital asthma self-management (DASM) program found that study participants who interacted consistently with the app had significantly greater improvements in symptom control compared with those who received usual care.
The mean Asthma Control Test (ACT) score, the study's primary outcome, increased by 4.6 points in the DASM group versus 1.8 points in the control group, for an adjusted between-group difference of 2.8 points (95% CI, 2.0–3.6; P <.001). Investigators reported unequal distribution of benefit, however, with the effect significantly attenuated among African American participants, suggesting that engagement or cultural tailoring may need refinement for this population should the program be developed further, authors suggested. The findings were published July 17 in JAMA Network Open.
Digital health technologies (DHTs) may provide a scalable strategy to help improve asthma outcomes, first author Jordan Silberman, MD, PhD, from the office of medical policy and technology at Elevance Health Inc, in Palo Alto, CA, and colleagues wrote. Previous research has been underpowered and of limited duration, however, and even clinical guidelines from the Global Initiative for Asthma have called for high-quality research.
Silberman et al cite colleagues who write that DHTs targeting asthma "should provide benefit...for groups disproportionately impacted by asthma, including those with low income, Hispanic or Latino adults, and Black or African American adults," populations known to experience higher rates of exacerbations and emergency department visits. While smartphone access is high in these groups (up to 80%), evidence for DHTs in reducing asthma disparities remains limited. The Asthma Digital Study was designed to build this evidence base.
The decentralized, open-label trial enrolled 901 adults from across the U.S. between October 2020 and November 2021, with 899 included in the final analysis. Participants were randomized to receive either usual care or access to the DASM program, which provided tailored symptom tracking, biometric feedback, educational tools, and medication reminders via app. Both groups received wearable devices, but only the intervention group had access to DASM features.
The study population was relatively young (mean age, 36.6 years), predominantly women (71%), and racially and ethnically diverse. Approximately 22% identified as Black or African American, 14% as Hispanic or Latino, and 24% were Medicaid insured, which served as a proxy for lower socioeconomic status.
The validated 5-item ACT measures asthma symptom control with a minimal clinically important difference (MCID) of 3 points. In the DASM group, those with uncontrolled asthma at baseline improved by an average of 4.6 points, exceeding the MCID. By contrast, the control group improved by just 1.8 points. While improvements were statistically significant in both groups, the between-group difference strongly favored DASM, according to the study.
Silberman and colleague quantified the disparities in program benefit across subgroups. Among African American participants, the between-arm difference in ACT change was 1.0 (95% CI, −0.7 to 2.7; P =.26), which was not statistically significant. In contrast, participants who did not identify as African American had a difference of 3.3 points (95% CI, 2.4–4.2; P <.001). The interaction between race and treatment effect also was significant (P = .02), while no such interaction was observed for ethnicity or insurance status.
The authors suggest that lower engagement may explain reduced benefit in some groups. African American participants used the app less frequently, and higher engagement overall was associated with greater ACT score improvements—1.9 to 2.2 points more in the top engagement quartiles. This suggests that active use of the tools contributed meaningfully to effectiveness.
DASM users also showed modest improvements in medication adherence, readiness to change, confidence in self-management, and work productivity, reinforcing the added value of digital interventions.
Among the study's limitations Silberman and colleagues acknowledge requirement for iPhone ownership, exclusion of uninsured individuals, and the open-label design, which could introduce bias.
Despite these factors, the authors concluded that DASM can improve asthma control in adults and represents a scalable, accessible option for many. However, the diminished benefit observed in African American participants underscores the need for culturally tailored content and more inclusive engagement strategies. Full results on healthcare utilization and cost outcomes are expected in future publications, they said.
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