Implementing and Evaluating the Clinical Outcomes of an Asthma Management Mobile Application

Background: The New York City borough of the Bronx has epidemic rates of asthma morbidity and mortality, and mobile health interventions are an effective way to reduce disease burden among patients. ASTHMAXcel is a mobile health platform previously shown to improve asthma control, knowledge, and quality of life. This study was designed to evaluate an adapted version (ASTHMAXcel PRO) of the platform in the out-patient primary care setting over 12 months, evaluating the digital tool's impact on asthma control in adults. Methods: Adult subjects with asthma on daily controller medications were recruited from the primary care setting and randomized to intervention and control (usual care) groups. Subjects were assessed at baseline and 12 months with the Asthma Control Test (ACT) and Mini-Asthma Quality of Life Questionnaire (mini-AQLQ). Paired t tests were used to compare time points within each group. Linear mixed models (LMM) adjusting for age, sex, insurance, and comorbidity were compared between groups by testing the interaction between time points (12 months vs baseline) and group. Results: The analysis sample included 99 subjects (48 in the intervention group, 51 in usual care), ranging from 20 to 72 years of age. There was a statistically significant increase in ACT scores in the intervention group between the baseline and 12 months (P = .004) but not so in the control group (between-group comparison, LMM interaction P = .08). Mini-AQLQ scores in both groups increased significantly (π = .005, P_c = .02), with a greater magnitude increase in the intervention group (between-group comparison, LMM interaction P = .24). Conclusions: This mobile platform is a promising resource for patients and is a step toward creating effective long-term interventions to improve patient quality of life and symptom control.