Library: The Lancet – Could an electronic tool to assess asthma control with a 1-day timeframe be useful for clinical management?

Asthma is a heterogeneous disease defined in part by a history of respiratory symptoms that vary over time and in intensity. Therefore, symptom assessment is at the core of asthma management, and leveraging mobile health (mHealth) apps to remotely monitor it is a promising strategy in clinical practice and research, especially because most of the population owns a smartphone in the present day.

Technology is focusing on dealing with asthma 

However, the wide variety of mobile apps available for asthma with different purposes, such as health education, symptom recording, or medication reminders, could lead to fragmented information.

The study

In The Lancet Digital Health, Bernardo Sousa-Pinto and colleagues present the development and validation of a score for electronic daily asthma control (e-DASTHMA). They describe the analysis of 135,635 1-day observations from 1,662 users of the MASK-air app who were treated for asthma.

First, they developed a set of data-driven scores based on reported asthma symptoms (from a 0–100 visual analogue scale [VAS]) and medication administered, and assessed their construct validity, test–retest reliability, and responsiveness.

Second, they performed an external validation using a cohort of patients with physician-diagnosed asthma who reported the daily effect of asthma symptoms on work or school activities through another app (InspirerMundi).

This external validation also included a comparison of the developed scores with the Global Initiative for Asthma (GINA) patient classification rated by the physician, through area under the receiver operating characteristic curves. e-DASTHMA was referred to as a digital biomarker that can complement existing instruments that measure asthma control within longer time frames (1–4 weeks).

A new approach

This study uses a novel approach to measure asthma control by focusing on both symptoms and medication administered during a single day. Existing questionnaires either do not have a specific question about medication (the Asthma Control Test and Asthma Control Questionnaire) or have a single question that only addresses the need to increase medication (Control of Allergic Rhinitis and Asthma Test).

e-DASTMA, however, specifically asks about the medication administered that day. For example, consider two people with asthma reporting the same amount of symptoms (VAS 30), but with different treatments. The patient who took an inhaled corticosteroid with formoterol that day would have a e-DASTHMA score of 25·6, and the patient who took an inhaled corticosteroid and a short-acting β-agonist would have a score of 32·8, which according to the cutoff point for e-DASTHMA (≥28·9) indicates worse asthma control.

Hence, the second patient would be a candidate for a treatment change according to the GINA stepwise approach1 after assessing other aspects of asthma management, such as treatment adherence or inhaler technique.

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