Telehome Monitoring of Symptoms and Lung Function in Children with Asthma

Background: The ability to perceive bronchial obstruction is variable in asthma. This is one of the main causes of inaccurate asthma control assessment, on which therapeutic strategies are based. Objective: Primary: To evaluate the ability of physicians to characterize the bronchial obstruction perception profile in asthmatic children using a clinical and spiro-metric telemonitoring device. Secondary: To evaluate its impact on asthma management (control, treatment, respiratory function variability) and the acceptability of this telemonitoring system. Methods: 26 asthmatic children aged 6−18 years equipped with a portable spirometer and a smartphone application were home-monitored remotely for 3 months. Clinical and spiro-metric data were automatically transmitted to a secure internet platform. By analyzing these data, three physicians blindly and independently classified the patients according to their perception profile. The impact of telemonitoring on the quantitative data was assessed at the beginning (T0) and end (T3 months) of telemonitoring, using matched statistical tests. Results: Patients could initially be classified according to their perception profile, with a concordance between the three observers of 64% (kappa coefficient: 0.55, 95%CI [0.39; 0.71]). After discussion among the observers, consensus was reached for all patients but one. There was a significant >40% decrease in FEV1 and PEF variability, with good acceptance of the device. Conclusions: Clinical and spiro-metric tele-home monitoring is applicable and can help define the perception profile of bronchial obstruction in asthmatic children. The device was generally well accepted.