Technology Tweaks Asthma Self-Management Programs for Adolescents

The technologies of texting, phone apps, and social media are being applied to asthma self-management programs for adolescents to enhance adherence to medication and effective response to symptoms. A recent review of the formats finds that those which are evidence based and customized to the target patient population are the most likely to foster improvements in asthma control tests and quality of life.

Self-management programs have been an essential part of asthma treatment since the 1970s, according to Deborah Liptzin, MD, and Stanley Szefler, MD, of the University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.

Their review of the progress from early "Crisis Plans" and "Asthma Action Plans" (AAPs) to the current technology based approaches was published on-line October 10 in The Journal of Pediatrics.

"Although some patients with asthma are poorly controlled despite excellent adherence to maximal therapy, most patients with poorly controlled asthma have poor adherence and/or poor recognition of symptoms," Liptzin and Szefler explain. "Indeed, fatal asthma has been attributed, in part, to poor self-management."

The reviewers note that adolescents are in particular need of well-accepted and effective self-management programs, as poor adherence often follows from a variety of reasons ranging from competing priorities to belief that medications are unnecessary.

With an estimated 88% of teenagers having smartphones, and an increasing number of applications developed for fitness and health, it seems inevitable that there would be a proliferation of tools designed to improve asthma control. The reviewers found that to be the case, with over 200 apps for this purpose in the iPhone app store. They also found, however, that many are not evidenced based, and that 25% were deleted after being issued.

Several text messaging tools have been evaluated in studies, with most found to be well accepted and associated with some improvements in adherence, but generally without measurable improvements in asthma control tests and quality of life.

Mobile apps have offered the possibility of better communication between patient and care-giver than the texting programs, the reviewers noted. When used in conjunction with monitoring devices, selected programs have enabled direct tracking of both adherence and asthma control.

Social media platforms are also being adapted to facilitate asthma self-management. One example the reviewers encountered is a private Facebook group for adolescents with asthma coordinated by The Center for Connected Health. The program includes educational information and reminders to take monthly asthma control tests on a secure website. The program was associated with higher rate of asthma control testing and greater improvement in control test scores than in a control group, with lower scores prompting referral to an asthma specialist.

"Savvy researchers will need to explore these additional platforms for capturing adolescents' interest," Liptzin and Szefler recommend, "and continually update their programs as social media evolves."

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