By David Stempel, MD, Senior Vice President of Clinical and Medical Affairs at Propeller Health
Asthma is often thought of as a single disease. If only it were that simple.
The symptoms of asthma may vary dramatically from patient to patient. Age of onset, triggers and mechanism of disease are factors that also influence the symptoms of asthma, the way the disease is expressed and its severity.
Conventional, guideline-driven interventions for asthma are a great starting point, but they are often applied without regard for individual history. Digital health interventions can deliver more personalized medicine by addressing the complexities of a disease and the individual patient.
We recently partnered with research scientists from Children’s Hospital Colorado to better understand two of the most challenging complexities of asthma: medication adherence and the assessment of asthma control.
Medication adherence represents a complex set of patterns
In order to identify the best asthma treatment pathway for an individual, it’s critical to begin by assessing their baseline controller medication adherence.
In the first study, we used Propeller to passively collect medication usage data for 1,249 asthma patients across various age groups. Much like the symptoms of asthma, it turns out that medication adherence varies from patient to patient but can be grouped into four patterns or phenotypes based on the level of adherence.
We found that the participants’ initial adherence was indicative of their adherence patterns over the entire study period. During the first four weeks, a pattern of adherence is established that is reflective of the pattern observed over the next five months.
These results confirm that digital monitoring of asthma controller medication adherence can help identify adherence patterns of use, and suggest the need for different treatment strategies for these unique groups. For example, interventions designed to promote medication adherence should be targeted during the first weeks of treatment. Age specific insights may be needed.
A new way of assessing asthma control
Two decades ago, the development of the Asthma Control Test (ACT) and the Asthma Control Questionnaire (ACQ) were major advances in determining whether patients needed to step-up or step-down their asthma care.
Both of these validated, standardized tools assisted decision making in the absence of reliable patient information. Nearly 20 years later, with the use of electronic monitoring, data is now available that can be used to more accurately inform medical decision-making and advance personalized medical care.
The second study, also conducted in partnership with research scientists from Children’s Hospital Colorado, helped validate this idea. The study compared passively-recorded SABA (Short-Acting Beta-Agonist, commonly referred to as rescue medication) use to self-reported SABA use among 748 adults with asthma. Passively recorded data was collected using Propeller’s digital sensors, while self-reported data was collected monthly using the electronically-delivered Asthma Control Test (ACT), which requires patients to recall their SABA use over the previous four weeks.
The research team found that ACT scores correlated better with SABA use in the prior week than in the prior four weeks. The ACT provides retrospective snapshots of control and places greater burden on patients to complete when compared to passively-collected data from digital sensors.
SABA use that is passively-collected through digital health interventions like Propeller may provide a more comprehensive evaluation of day-to-day variability in asthma control. Digital sensors may also reduce reporting biases, making them a better option for identifying who needs an intervention, what type of intervention is needed – and when they need it.
These research abstracts originally appeared in The American Journal of Respiratory and Critical Care Medicine. Propeller Health co-presented the abstracts alongside research scientists from Children’s Hospital Colorado at the American Thoracic Society (ATS) conference in May, 2018.