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Research shows a mobile app–based asthma intervention yielded a statistically significant improvement in asthma-related QOL for patients with low activation.

A mobile app–based asthma symptom monitoring intervention yielded a statistically significant—but not clinically meaningful—improvement in patient-reported asthma-related QOL, according to a study published online in JAMA Network Open.

Despite not meeting the prespecified minimally important change threshold of 0.5 on the seven-point Mini Asthma Quality of Life Questionnaire (MiniAQLQ), the authors noted a targeted benefit among certain subgroups. “Patients with low levels of self-assessed activation (defined by knowledge, skills, and confidence in managing their health) may derive perceptible benefit,” wrote corresponding author Robert S. Rudin, PhD, and colleagues.

Study Design & Intervention

The randomized clinical trial involved 413 adults with physician-diagnosed asthma from seven primary care clinics affiliated with Brigham and Women’s Hospital, Boston, Massachusetts. Participants assigned to the intervention arm were instructed to use a smartphone app weekly to complete a five-item asthma symptom questionnaire; track notes, peak flows, and triggers; and view educational materials. They were also provided options to request a nurse callback for problematic symptoms and to receive visit reminders. The intervention included a primary care clinician-facing EHR dashboard and a nurse-facing practice model. Those assigned to usual care received an email containing general asthma-management guidance.

Outcome Assessment

Of the initial cohort, 366 participants (176 intervention; 190 usual care) completed the final 12-month MiniAQLQ assessment and were included in the primary efficacy analysis. Mean MiniAQLQ scores increased by 0.34 points in the intervention group versus 0.11 points in the control group. Although this between-group difference achieved statistical significance, the change fell short of the researchers’ predefined minimally important difference of 0.5 points, indicating an effect size below the threshold deemed clinically meaningful.

Secondary & Subgroup Analyses

A secondary analysis evaluated nonroutine asthma-related healthcare utilization events—emergency department visits, urgent care visits, and hospitalizations—over 12 months. Intervention participants experienced a mean of 0.59 events, compared with 0.76 events among usual care participants.

Exploratory subgroup analyses revealed larger intervention effects in several cohorts. Among patients with low baseline scores on the Patient Activation Measure, the adjusted difference-in-differences in MiniAQLQ scores favored the intervention by 0.77 points. Younger adults (ages 18–44) experienced a 0.40-point advantage, while those with low baseline MiniAQLQ scores showed a 0.33-point improvement. Intriguingly, participants demonstrating low adherence to the intervention reported a mean 0.68-point gain, versus 0.25 points among high-adherence participants.

Low Activation, Greater Potential

“The relatively larger effects on patients with low activation (and low adherence, which may be related to activation) may be because those patients have more potential to improve their knowledge, skills, and confidence in managing their health,” the researchers concluded. “Subgroups of patients, particularly those with lower levels of activation, may derive meaningful benefits and should be the focus of further development and testing.”