Modern medical science has made remarkable strides in the treatment of asthma. Steroid-containing inhalers are especially effective in preventing an asthma attack. But getting people to take these long-term preventative medications remains a challenge.
Because asthma is an ongoing condition, many people have difficulty taking their medication regularly because of busy schedules or because the medication does not appear to work immediately.
One potential solution lies in digital technologies that can reduce the risks associated with not taking the medication as prescribed. These technologies include text messaging reminders, web-based applications, interactive voice response systems, and smart inhalers.
The benefits could be considerable, as asthma is one of the most common health problems. It affects up to 339 million people worldwide. New Zealand has one of the highest rates of asthma, with one in seven children and one in eight adults.
Asthma attacks are also the most common cause of days out of school and work for people with the disease. In the UK, it is estimated that someone has a life-threatening asthma attack every ten seconds, with similar data in New Zealand. Asthma mortality is higher among Maori and Pacific peoples, with rates 4.3 and 3.2 times higher than in other groups.
While there are inhalers that work well on immediate symptoms, preventative medications are key to controlling long-term asthma. These should be taken as prescribed, often once or twice a day. What is known as “non-adherence” to these regimens is a major health problem and can lead to more symptoms and attacks.
Preventive treatments can be very effective, but following a prescription is a challenge for many. Getty Images
Medication adherence strategies
Therefore, gaining adherence is very important to reduce the risk of death. With increasing investment in digital technologies designed to improve health, the goal of asthma research is to improve the way existing drugs are used and therefore improve outcomes.
Research in New Zealand has shown that “smart” inhalers (devices that control when doses are taken and can provide reminders and feedback) improve medication adherence by 50% and improve control in children with asthma. .
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But we still don’t know if digital technologies in general can improve the situation of all people with asthma and, even if they do, whether this will have a positive impact on asthma symptoms or attacks.
For more information, we analyzed all randomized controlled trials of digital technologies and their impact on adherence to asthma medication. We found 40 studies around the world, with a collective sample base of more than 15,000 adults and children with asthma.
By pooling data from all separate trials, 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 did not.
How digital technologies can help
Simply put, digital technologies can work to improve asthma medication intake.
On average, 15% more people took their medications as prescribed when they had the technology, compared to those who did not (who took 45% of the prescribed amount of their medication).
This 15% increase can have significant impacts on people’s asthma management, as more regular use of medications can reduce symptoms and reduce the risk of seizures.
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In all studies, people with access to digital technology had fewer asthma symptoms and, on average, half the risk of asthma attacks compared to people who did not receive the technology. These benefits could reduce the risk of asthma-related deaths.
We also found that people who had the technology had a better quality of life and lung function, although the effect on lung function was small and may have limited clinical significance.
Digital technologies can help, but they may not be for everyone, and some may work better than others. Shutterstock
Daily asthma care
For people with asthma who have difficulty taking their medications regularly, digital technologies are likely to help improve their medication intake, which in turn can reduce asthma symptoms and attacks.
But we need more research on how these technologies can be integrated into routine asthma care. The available studies do not tell us enough about the effects on free time from work or school, the cost-benefit ratio or whether there are harmful results.
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In addition, digital technologies may not work for everyone. Although research shows that users generally accept the technologies, people did not complete the full study in approximately 25% of the studies we reviewed.
Some technologies may also work better than others. We found that smart inhalers and text messaging systems seemed better at improving medication intake than other types of technology. But the small number of studies means that we cannot be completely sure that these technologies will work better.
Future technological potential
Digital technologies are constantly evolving and are likely to play an even more important role in the future care of asthma. Devices such as smart watches can monitor changes in a person’s physiology in real time.
These changes could 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.
This risk prediction is the subject of current research funded by the Auckland Medical Research Foundation and the Health Research Council.
If it is shown to work, we could see a substantial change in how asthma is managed. Users may one day be able to monitor their asthma control status simply by looking at their phones.