Study: Text Message-Based Care Program Can Boost Asthma Outcomes

Asthma patients who are given electronic asthma plans have better health outcomes, according to a new pilot study published this month.

Researchers from the University of British Columbia wanted to find out whether an electronic asthma action plan (eAAP) would outperform paper plans in such a way that would translate into improved asthma control and health outcomes.

The team constructed a pilot study with 106 patients, half of whom were given paper AAPs, and half of whom were given eAAPs. Each of the patients included in the study reported having at least one asthma exacerbation within the previous 12 months.

Those on the electronic plan received a weekly text message asking them to assess their asthma control and to engage with their action plan. After 1 year, the eAAP cohort had lower incidences of asthma exacerbations, with a 0.82% risk ratio compared to those on the paper plan.

The study also noted higher scores for asthma control and quality of life among eAAP patients versus paper AAP patients, though those increases were not deemed to be statistically significant.

Still, the authors, including corresponding author Mark FitzGerald, MB, MCh, BAO, MD, of the Institute for Heart and Lung Health at the University of British Columbia, said the results were significant enough to warrant a larger randomly controlled trial.

“We demonstrated that the eAAP presented improved asthma control outcomes, but as expected the sample size was inadequate to show a significant difference but based on this pilot study we plan a larger appropriately powered RCT,” the researchers wrote.

One other important finding from FitzGerald and colleagues is that a significant percentage of patients are willing to engage with a text message-based health intervention. The team reported that the cumulative response rate for all weekly text messages was 68.4%. A total of 28% of patients checked their eAAP during the intervention period.

The new study adds to an existing body of scientific evidence that has broadly found benefits to text message interventions, but with varying caveats and limitations.

A small 2013 study by the Georgia Institute of Technology, for instance, looked at the impact of text messages on pediatric patients with asthma. Some patients received daily text messages that asked about symptoms and tested their knowledge about asthma. Another cohort received messages assessing their asthma knowledge every other day.

Like the new study, the 2013 Georgia Tech study showed that text message reminders can improve patient outcomes. However, the Georgia Tech study showed the outcomes only in the patients who received daily texts, not those who received texts every other day.

A review article published that same year looked at 6 studies on the topic and found that text reminders seemed to boost patient medication adherence, but did not improve clinical asthma outcomes or asthma-related quality of life ratings. The article suggested longer-term studies would be needed to fully explicate the benefits, if any, of text interventions.

The study, “A pilot randomized controlled trial on the impact of text messaging check-ins and a web-based asthma action plan versus a written action plan on asthma exacerbations," was was published online in the Journal of Asthma.