Smartphone apps have great potential to improve patient care for asthma. The most recent Canadian Thoracic Society asthma guidelines emphasize the importance of asthma education, self-monitoring and self-management (1). This is because asthma is a dynamic disease that can be exacerbated by triggers that require treatment modification, sometimes urgently. When patients effectively monitor their symptoms, understand their triggers and adjust treatment in response to their symptoms, they are able to reduce their asthma exacerbations and emergency care use (2). Many patients are not adequately informed about their disease and their triggers. Many do not understand the differences between their medications, how to correctly use them and how to escalate their treatment when symptoms worsen. Apps have the potential to help by providing asthma education between physician visits, allowing patients to more easily self-monitor their condition and helping them self-manage medications in response to their symptoms.
We selected four apps for clinical review. One of the apps is focused on patient education. The other apps focus on self-monitoring with symptom journaling. Most of the apps provide medication reminders to help patients remember to take their controller medications. The AsthmaMD app stands out because it has a built-in action plan that is activated by patients having a peak flow reading in the ‘yellow zone’.
This app was released by the U.S. Allergy & Asthma Network and is powered by Health Storylines. Health Storylines is a customizable mobile and Web-based app used by patients to manage their health; it’s a product of Self Care Catalysts, a Canadian patient intelligence and solutions company. The Allergy & Asthma Network is a non-profit patient education and advocacy organization for people with asthma and allergies. Its website contains educational readings and resources such as an asthma action plan. The app, however, is limited to a basic asthma symptom tracker in a branded version of the Health Storylines app. The app includes a medication compliance tracker for controller medications but does not track use of rescue medication. The app allows users to track customizable symptoms and peak flow readings and displays them in a weekly graph. The app includes a section for the Asthma Control Test but simply links to an image of the test and does not allow users or save their information for tracking. This app may be helpful for users looking for a symptom journaling tool but is in no way a comprehensive asthma self-monitoring and management tool.
The core feature of this app is a symptom tracker. It allows users to rate their asthma symptoms daily and then creates weekly graphs with this data. The app unfortunately does not let users track their rescue medication use which is important in assessing asthma control. It also does not allow users to track asthma triggers. The app offers an Asthma Control Test as a non-modifiable image file requiring users to add up their numeric answers on their own. Users cannot track their Asthma Control Test result. There are no asthma educational features in the app and no acute asthma management tools.
Because of its limited scope as a symptom tracker this app is unlikely to be effective on its own for asthma self-management. The Health Storylines platform has some good design features, however, and there is potential for this app to be improved by including additional asthma-specific tools.
It is surprising to see a widget for tracking daily mood and a widget for getting an inspirational quote displayed so prominently when getting started with the app; they are clearly not relevant to asthma self-monitoring. The core feature, the symptom tracker, is simple enough for most users to get started with. The graphs that are generated are elegant but can only be displayed by week, making it difficult to quickly assess control between clinical appointments spaced months apart.
Privacy & Security+-
The app was fast and did not crash during testing. The app has had frequent updates since it was launched in 2015.
The app is free and is available in both the Android and Apple app stores. The app may confuse many users about what is important for effective asthma self-management as the app includes some tools that are clearly not important while leaving out others that are.
Asthma Australia – Asthma App
This app was created by Asthma Australia, an asthma education and advocacy organization. The goal of the app is to provide a mobile education tool for health professionals, people with asthma and their caregivers. The app does not offer a journaling tool. It includes some great features such as videos on how to properly use inhalers and information on acute asthma management. It also includes a medication section outlining common asthma medications but does not adequately explain the different types of medications and their uses. Overall the app is a good mobile educational tool but would need to be used with an asthma journaling tool for comprehensive self-management.
The scope of the app is limited to asthma education. It includes a first aid section that users can quickly access for reminders on how to manage an asthma attack. An asthma control test is included with a description of what the results mean, but unfortunately there is no data input and users have to add up their answers to the questions on their own. A blank asthma action plan is included as an unmodifiable image file. Being able to enter personal action plan info so the app could offer individualized first aid would be more useful.
Asthma education is an important component of self-management and many patients would find it helpful to have a mobile educational resource to use between visits. This app does a good job of explaining the basics of asthma and its management. The tool’s effectiveness as an educational tool, however, is not validated by research. It offers a basic medication education section but would benefit from a more thorough explanation of the different types of inhalers and when they are used. As is, this section would not help most users better understand their medications. The app was developed for an Australian audience but the educational tools are still relevant for Canadians.
On first launch, the app provides users with a well-outlined description and purpose statement. The app has a clean interface that is simple and friendly to use.
Privacy & Security+-
The app does not collect user data, suggesting privacy/security are unlikely of concern. There is no privacy statement available for the app.
The app has had several updates since its launch in 2016. It did not malfunction or crash during testing.
The app is available for free but is currently only available in the Apple app store. The language used in the app is simple and would be easy to understand for most users.
A product of Swiss healthcare applications and data management company haako gmbh, this app is an asthma journal designed to help users track their asthma control and use of rescue medication to help them and their provider optimize their care. Its strength is its simple and intuitive user interface which allows various aspects of asthma control to be entered and visualized in graphic form. The Apple version of the app communicates with the built-in Apple Health app to access users’ footstep counter data to help identify exercise-induced symptoms. The app also saves peak flow readings to the Health app so users can access their readings even if they stop using Asthma Tracker. The app offers medication and peak flow reminders. The app could be improved by incorporating additional features such as controller medication compliance, tracking medication changes, triggers, an action plan and educational tools.
This app is limited in scope, only offering an asthma journal. The journal includes some important data such as peak flow readings, rescue inhaler use, symptoms and Asthma Control Test results. However it doesn’t track other important data such as medication compliance, medication changes and asthma triggers. There are no educational tools integrated in the app and it does not provide advice, alerts or an action plan when control is poor.
Self-monitoring is an important part of asthma management and this app tracks some, but not all, relevant data. It would be more effective if it included additional data tracking. The effectiveness of this app has not been validated by research.
The app has a clean interface that is intuitive to use and allows for quick data entry. It displays the data in a way that is easy to understand but does not allow users to see aggregated data for weeks, months or the time between medical visits.
Privacy & Security+-
The app has frequent updates and the company is actively seeking feedback on its website so it can continue to improve the app. The company does not offer tech support. The app worked well during testing and did not crash.
The app is free and is available in both the Android and Apple app stores. The app is simple and accessible for most users. It provides an in-app Asthma Control Test. It unfortunately does not provide users with feedback on what the test is and what their score means which is a possible patient safety concern.
This app was created by pediatrician and University of California, San Francisco medical school faculty member Dr. Sam Pejham to give patients a tool to help them manage their asthma. It also collects real-time data for asthma research. The app offers a daily log of symptoms, triggers, medication use and peak flow readings to help patients and their physicians better assess asthma control. While the company sells a branded peak flow meter ($30.50 on amazon.ca), readings are entered manually into the app making it possible to use the app with any peak flow meter. The app stands out for incorporating a customized asthma action plan that is activated when a user’s peak flow reading is in the yellow zone, and then proceeds to step them through acute treatment. The app also offers data-sharing and medication reminders. This app supports effective journaling and provides a built-in action plan; it’s a great option for many patients with asthma.
This app allows patients to self-monitor their asthma control by tracking peak flow readings, symptoms and triggers. Users are able to view their peak flow readings on a graph organized by green, yellow and red zones. All other data can only be viewed in daily log form. Rescue medication journaling is limited to whether a patient used rescue medication on a particular day; it does not summarize usage graphically. The app offers a built-in asthma action plan that is customizable and can be activated both manually or triggered by a yellow zone peak flow reading. The app contains links to YouTube educational videos. The app requires users to have a peak flow meter as monitoring peak flow is a core feature of the app. The company sells a branded peak flow meter, but readings are entered manually into the app so it is possible to use the app with any peak flow meter.
It is likely that users who have good compliance using this app could gain insight to more effectively manage their asthma. This, however, has not yet been validated by research. Because the app summarizes only peak flow readings it may be difficult for patients to find trends in their other data. The built-in action plan is a good resource to help users treat their acute symptoms.
A user guide video is available online. Users are required to register before getting started. The app makes it easy to set up a personalized asthma action plan that can be used for future asthma attacks.
Privacy & Security+-
The company requires users to register before using the app with personal information such as name, e-mail and date of birth. The app collects additional data such as location information, medications and peak flow readings. No privacy information could be found online but the company does state that it collects anonymous user data that is used in aggregate form for research purposes. It does not specify whether this is academic or industry research.
The app has had frequent updates since its launch in 2010. The company is actively seeking feedback on the product so it can continue to improve it. Help for using the app is also available by email.
The app is free and available in both the Android and Apple app stores. The app is clear and accessible for most users.
What Experts Say
Watch our interview with leading respirologist Dr. Shawn Aaron.
It’s a marriage made in heaven. Both patients and their health care providers want mobile health devices to help manage asthma and evidence supports the value of self-management.
In 2015, Asthma UK asked patients and healthcare professionals for their views on what they would like from a mobile health system. Nearly three-quarters of patients wanted to see a mobile health device that would help them monitor their asthma. In addition, nearly half suggested they would value a system which could be used as part of their asthma action plan and tell them if changes to asthma medication have improved their asthma and when to seek medical attention.
More than three-quarters of healthcare professionals said they would value a mobile health system that would monitor patients’ asthma symptoms over time and provide patients with an asthma action plan.
Another survey asked people with asthma (186) and healthcare providers (63) what they valued in mobile health solutions. Individuals with asthma most frequently requested a mobile health system to monitor asthma over time (72%) and to collect data to present to healthcare teams (70%). A system alerting patients to deteriorating asthma control (86%) and advising them when to seek medical attention (87%) were most frequently selected by the healthcare providers.
According to a synthesis of the evidence supporting self-management, “The randomized controlled trial evidence for the efficacy of self-management is extensive and overwhelmingly positive. Our findings suggest that self-management support can be implemented effectively in routine practice with significant improvements in morbidity and even mortality.”
Asthma UK summed it up in 2016’s “Connected Asthma: How technology will transform care: ‘Given the size and nature of the asthma population, the unmet need, and in particular the strength of the evidence for asthma self-management, there is a compelling argument to make asthma a focus and an exemplar for investment in technology-enabled self-management and clinician-led management in primary care.’”
- Lougheed MD, Lemiere C, Ducharme FM, Licskai C, Dell SD, Rowe BH, et al. Canadian Thoracic Society 2012 guideline update: diagnosis and management of asthma in preschoolers, children and adults. Canadian respiratory journal : journal of the Canadian Thoracic Society. 2012;19(2):127-64.
- Pinnock H. Supported self-management for asthma. Breathe. 2015;11(2):98-109.