Smartphone-based vs paper-based asthma action plans for adolescents

Background: Adolescents with asthma are at risk of poor outcomes and are traditionally difficult to reach. Objective: To examine adolescents' use of and asthma outcomes associated with smartphone-vs paper-based asthma action plans (AAPs). Methods: We conducted a 6-month randomized clinical trial with adolescents (12-17 years old) with persistent asthma. Participants used their respective smartphone or paper AAPs for medication instructions and peak flow or asthma symptoms logging. AAP use was measured electronically for smartphone users and via mail-in diaries for the paper group. Changes in Asthma Control Test (ACT) and self-efficacy scores were examined. Results: Thirty-four adolescents participated in this study (median age, 15.4 years). Participants were mostly African American (62%) with state-issued insurance (71%). Adolescents in the smartphone group accessed the AAP a median of 12.17 times per week or 4.36 days per week but only recorded medications or symptoms and peak flow data in the electronic diary a median of 10 days per month during the 6-month period. Participants in the paper group recorded data a median of 23.5 days per month on their paper diaries. Overall, there were no changes in ACT and self-efficacy scores between groups. Adolescents with uncontrolled asthma (baseline ACT score <= 19) had an improvement in ACT for the smartphone group (before, 11; after, 20) ([P =.04) compared with no change in the paper group (before, 17; after, 17) (P =.64). Adolescent satisfaction with the application was high, with 100% stating they would recommend the smartphone AAP to a friend. Conclusion: Adolescents were frequent and highly satisfied users of the smartphone AAP with a subset of participants with uncontrolled asthma demonstrating possible clinical benefit. Findings suggest a need for larger-scale studies to determine the effectiveness of smartphone-based AAPs among high-risk patients with asthma. Trial Registration: clinicaltrials. gov Identifier: NCT02091869. (C) 2016 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.