Remote monitoring in asthma: a systematic review

Poor adherence to maintenance inhalers and incorrect maintenance and reliever inhaler technique are associated with poor asthma outcomes. Remote therapeutic monitoring and remote patient monitoring support asthma guideline recommendations to regularly review adherence and inhaler technique, with the ultimate goal to improve asthma outcomes.

This work systematically reviewed all clinical trials testing remote monitoring interventions on asthma outcomes.

A systematic search of PubMed, SCOPUS, Ovid, CINAHL and reference review databases was conducted from 1 January 2000 to 30 April 2024. Articles were included if the title or abstract included MeSH terms of "nebulizers and vaporizers" in combination with "digital", "remote", "electronic" or "smart inhaler" to identify interventional studies testing remote monitoring for asthma. We characterised populations, interventions, control groups, outcomes, timeframe and setting across studies.

Of 2043 articles reviewed, 19 articles met the inclusion criteria (n=14 remote therapeutic monitoring; n=5 remote patient monitoring). While a wide range of outcomes were measured across studies, overall, the studies (n=19) that met the inclusion criteria demonstrated a slower decline in maintenance inhaler adherence (n=13), decreased reliever use (n=6) and improvements in asthma control (n=3). They did not demonstrate positive outcomes on asthma exacerbations and healthcare utilisation, but this may be due to study sample sizes, eligibility criteria and duration.

Remote monitoring demonstrates improvements in important intermediary asthma outcomes. Future studies with larger sample sizes, duration and requiring greater disease severity as eligibility criteria are warranted to evaluate their efficacy at decreasing asthma-related oral steroid use, emergency department visits, hospitalisations and costs.