The Asthma app as a new way to promote responsible Short-Acting Beta2-Agonist use in people with asthma: Results of a pilot study (Preprint)

Abstract

Approximately 262 million people globally are affected by asthma, and overuse of reliever medication – specifically, short-acting β2-agonist (SABA) overuse – is common. This can cause adverse health effects. A smartphone application, the Asthma app, was developed via a participatory design to help patients gain more insight into their SABA use through monitoring and psychoeducation.

This pilot study aimed to evaluate the feasibility and usability of the app. Furthermore, the preliminary effects of using the app after three months on decreasing asthma symptoms and improving Quality of Life were examined.

A mixed-method study design was used. Quantitative data was collected in the app. Asthma symptoms (measured with the Control of Allergic Rhinitis and Asthma Test [CARAT]) and the triggers of these symptoms were collected weekly. Quality of Life (Short-Form Health Survey [SF-36]) was assessed at baseline and after three, six and 12 months. User experience (System Usability Scale [SUS]) was measured at all time points, except for baseline. Furthermore, objective user data was collected and qualitative interviews, focusing on feasibility and usability, were organised. The interview protocol was based on the Unified Theory of Acceptance and Use of Technology (UTAUT) framework. Qualitative data were analysed via the Framework Method.

The baseline questionnaire integrated into the app was completed by 373 people. The majority were female (83%) with a mean age of 46, and used, on average, 10 SABA inhalations per week. App usability was rated as good: 80.71 (SD=14.8; n=53) at three months. The CARAT score significantly improved at three months (18.5) compared to baseline (14.8; β=.189, SE=.048, P<.001); however, the obtained score still indicated uncontrolled asthma. At three months, there was no significant difference compared to baseline regarding the quality of life. Due to the high drop-out rate, insufficient data was collected at six and 12 months and were therefore not further examined. User data showed that 335 users opened the app (75% were returning visitors), with an average session time of 1 minute, and SABA registration was most often used (57%). Qualitative data (n=4; 50% female) showed that participants found the app acceptable and clear. Three participants stated that gaining insight into their asthma and its triggers was helpful. Two participants no longer used the app because they perceived their asthma as controlled and, therefore, did not use SABA often or only used it regularly based on the advice of the pulmonologist.

Initial findings regarding the app’s feasibility and usability are encouraging. However, the notable drop-out rate underscores the need for a cautious interpretation of results. Subsequent studies, particularly those focusing on implementation, should explore the potential integration of the app into standard treatment practices.