But app use did not impact IV antibiotic need in study

Use of a first-of-its-kind smartphone app designed to monitor and report symptom changes in adults with cystic fibrosis was associated with earlier time to detection of exacerbations requiring oral or intravenous antibiotics in a prospective, randomized single-center trial involving 60 patients.

During 12-months of follow-up, the number of oral antibiotic courses increased among the adult CF patients randomized to app arm of the study, but no significant difference was seen in the total number of IV antibiotic courses patients required.

The app, which was developed by the study authors, allowed users to report symptom changes directly to their CF team with the goal of facilitating the earlier identification and treatment of exacerbations, wrote researcher Jamie Wood of Curtin University, Perth, Australia.

“To optimize adherence, the app was designed to exclusively utilize smartphone technology that was mobile and already owned by the majority of young adults in society,” the researchers wrote in the Journal of Cystic Fibrosis. “We hypothesized that by improving symptoms reporting and reducing the time to detect exacerbations, the risk of more severe exacerbations requiring treatment with IV antibiotics may be reduced.”

Wood and colleagues concluded that even though the findings did not support this hypothesis, “this study supports the continued development and investigation of similar apps and technologies used to identify exacerbations, with the aim of improving health outcomes.”

But in a letter later published in the same journal, Zhe Hui Hoo and Martin J. Wildman of North General Hospital, Sheffield, UK, and colleagues, wrote that it is not yet known if earlier exacerbation detection improves lung health in patients with CF, given the uncertainty about how to best manage early exacerbations.

They noted that in both the study by Wood and colleagues and the eICE study, which also examined a home monitoring strategy to identify exacerbations, more oral antibiotics were used in the monitoring intervention groups, but intravenous antibiotic use was the same or greater (eICE).

An analysis of eICE data found greater lung function recovery, as measured by FEV1, with intravenous compared to oral antibiotic treatment, “implying that oral antibiotics may be inadequate treatment for early exacerbations.”

Hoo and Wildman noted that two other home-monitoring trials with the goal of detecting early CF exacerbations are ongoing.

“As the CF population increases, there will be increasing pressure on staff time,” they wrote. “A meta-analysis of the four relevant home-monitoring trials might illuminate whether scarce resources are best invested downstream in detecting exacerbations or upstream in supporting self-care to prevent exacerbations. Investment in prevention is an attractive option when adherence to preventive therapies may be as low as 35-50%.”

The 60 participants in the Wood et al. study (29 females, mean age 31 ±9 years, FEV1 60±18% predicted) were randomized to the smartphone app intervention, which included weekly use of the app or sooner use when symptoms worsened, or usual care.

The app included 14 “yes or no” questions relating to symptoms, designed to identify early signs of exacerbations. When worsening symptoms were reported, the study participant was contacted by a nurse practitioner.

Twelve of the 14 app questions were adapted from the Fuchs exacerbation scale and 2 questions inquired about emotional wellbeing.

The primary outcomes were number of courses and days requiring oral or IV antibiotics.

During 12-months of follow-up, the study found:

  • No clear effect of the app on the number of courses of IV antibiotics (incidence rate ratio [IRR] 1.0; 95% CI, 0.6-1.7).
  • An increase in the use of oral antibiotic courses (IRR, 1.5; 95% CI, 1.0-2.2).
  • Shorter median time to detection of exacerbations requiring oral or IV antibiotics in the intervention group (70 [123] vs 141 [140] days in the usual care group [P=0.22]).
  • No between group differences in other outcomes, including inhaled antibiotic use, hospital admissions and CF clinic visits.

The adherence rate for the smartphone app on a weekly basis was 77% (range 25 to 100%), with 1,136 of a possible 1,483 reporting occasions completed. Subgroup analysis demonstrated an increase in oral antibiotic prescription and reduction in IV antibiotic prescription, compared with the year preceding study entry in 15 intervention group participants with ≥80% adherence.

“The high usability of our app is further supported by the low attrition from the intervention group (3%),” the researchers wrote. “This is considerably less than earlier studies of telehealth interventions in CF populations, in which attrition ranged from 24% to 63%.”

  1. Use of a smartphone app designed to monitor and report symptom changes in adults with cystic fibrosis was associated with earlier time to detection of exacerbations requiring oral or intravenous antibiotics.

  2. Over 12-months of follow-up, the number of oral antibiotic courses increased among the adult CF patients randomized to app arm of the study, but no significant difference was seen in the total number of IV antibiotic courses.

Salynn Boyles, Contributing Writer, BreakingMED™

Researchers Jamie Wood, Sue Jenkins, and Siobhain Mulrennan reported receiving grants from Sir Charles Gairdner Osborne Park Healthcare Group during the conduct of this study.

Cat ID: 491

Topic ID: 89,491,730,192,491,925