Digital Self-Management Platform for Adult Asthma: Randomized Attention-Placebo Controlled Trial.

Area of Science:

• Digital health
• Asthma management
• Clinical trials

Background:

• Asthma is a prevalent chronic condition with significant global health and individual burdens.
• Digital health applications offer accessible, cost-effective solutions for improving asthma self-management.
• Effective asthma control is critically dependent on robust self-management strategies.

Purpose of the Study:

• To evaluate the efficacy of the juli smartphone application for asthma self-management.
• To conduct a fully remote, pragmatic, single-blind randomized controlled trial (RCT).
• To assess the impact of juli on asthma control and related outcomes over an 8-week period.

Main Methods:

• A pragmatic, single-blind RCT involving 411 participants (aged 18+) with uncontrolled asthma (Asthma Control Test [ACT] score ≤19).
• Participants were randomized 1:1 to use either the juli app or a limited-attention placebo app for 8 weeks.
• Primary outcome: difference in ACT scores at 8 weeks. Secondary outcomes: asthma remission, minimal clinically important difference, asthma worsening, and quality of life.

Main Results:

• In the per-protocol analysis (n=152), juli users showed a significantly higher mean ACT score at 8 weeks compared to the control group (17.93 vs. 16.24, P=.02).
• Juli users had significantly greater odds of achieving a minimal clinically important difference in asthma control (OR 2.38, P=.01).
• Modified intention-to-treat analyses yielded similar results; however, patient retention in the trial was a challenge (63% attrition).

Conclusions:

• The juli app effectively improved asthma symptom control over 8 weeks compared to a placebo app.
• Juli demonstrates potential as a digital tool to supplement existing asthma care pathways.
• Patient retention remains a critical challenge for digital health interventions in randomized controlled trials and real-world applications.