Digital Action Plan (Web App) for Managing Asthma Exacerbations: Randomized Controlled Trial
Résumé
Methods: This randomized, unblinded, multicenter (offline recruitment in private offices and public hospitals), and parallel-group
trial included children (aged 6-12 years) or adults (aged 18-60 years) with asthma who had experienced at least 1 severe exacerbation
in the previous year. They were randomized to a WAP or DAP+WAP group in a 1:1 ratio. The DAP (fully automated) provided
treatment advice according to the severity and previous pharmacotherapy of the exacerbation. The DAP was an algorithm that
recorded 3 to 9 clinical descriptors. In the app, the participant first assessed the severity of their current symptoms on a 10-point
scale and then entered the symptom descriptors. Before the trial, the wordings and ordering of these descriptors were validated
by 50 parents of children with asthma and 50 adults with asthma; the app was not modified during the trial. Participants were
interviewed at 3, 6, 9, and 12 months to record exacerbations, UMCs, and WAP and DAP use, including the subjective evaluation
(availability and usefulness) of the action plans, by a research nurse.
Results: Overall, 280 participants were randomized, of whom 33 (11.8%) were excluded because of the absence of follow-up
data after randomization, leaving 247 (88.2%) participants (children: n=93, 37.7%; adults: n=154, 62.3%). The WAP group had
49.8% (123/247) of participants (children: n=45, 36.6%; mean age 8.3, SD 2.0 years; adults: n=78, 63.4%; mean age 36.3, SD
12.7 years), and the DAP+WAP group had 50.2% (124/247) of participants (children: n=48, 38.7%; mean age 9.0, SD 1.9 years;
adults: n=76, 61.3%; mean age 34.5, SD 11.3 years). Overall, the annual severe exacerbation rate was 0.53 and not different
between the 2 groups of participants. The mean number of UMCs per year was 0.31 (SD 0.62) in the WAP group and 0.37 (SD
0.82) in the DAP+WAP group (mean difference 0.06, 95% CI −0.12 to 0.24; P=.82). Use per patient with at least 1 moderate or
severe exacerbation was higher for the WAP (33/65, 51% vs 15/63, 24% for the DAP; P=.002). Thus, participants were more
likely to use the WAP than the DAP despite the nonsignificant difference between the action plans in the subjective evaluation.
Median symptom severity of the self-evaluated exacerbation was 4 out of 10 and not significantly different from the symptom
severity assessed by the app.
Conclusions: The DAP was used less often than the WAP and did not decrease the number of UMCs compared with the WAP
alone.
Domaines
Sciences du Vivant [q-bio]Origine | Publication financée par une institution |
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