Dr. Erkan Hassan

Monthly Writings

Evaluations and reviews of the latest in the field.

Asthma Outcomes with Remote Device Telemedicine

SUMMARY:

  • Asthma is a common disease affecting both children and adults with 262 million cases worldwide.

  • In addition to an economic burden, asthma leads to premature mortality and diminished quality of life.

  • Adherence rates with inhaled medications remains low.

  • Telemedicine has emerged as an efficient alternative in delivery of care.

  • These remote tools have mixed results in providing positive outcomes on asthma exacerbations and healthcare consumption.

REVIEW

  • There are approximately 1.84 million emergency department asthma visits annually in the U.S.

  • Asthma kills approximately 1 in every 250 people globally and has a major economic burden in terms of direct and indirect costs.

  • The main treatment approach of inhalation therapy is often suboptimal due to poor adherence and errors in technique.

    • Medication adherence rates in asthma range from 13 to 52%.

  • Telemedicine has emerged as an efficient alternative in delivering pulmonary rehabilitation programs

  • There are 2 major components to respiratory telemedicine:

    • Remote Patient Monitoring (RPM) is used to track physiologic data with the goal of detecting early signs of disease exacerbation, assess lung trends and worsening status.

    • Remote Therapeutic Monitoring (RTM) is used to monitor non-physiologic data with the goal of ensuring a treatment plan is adhered to and successful.  It reports on data such as: inhaler usage and adherence; recording of symptoms; medication adherence; track breaths and patterns.

  • Significant discrepancies exist between clinician assessments, patient self reports and electronically measured medication adherence.

  • Abbreviations:

    • ICS: Inhaled corticosteroid

    • SABA: Short acting beta agonist

    • EMM: Electronic medication monitor

  • Various types of lung monitoring devices:

    • Mobile spirometry

    • Peak flow meter

    • Pulse oximeter

    • Portable capnography

    • Smart inhalers

    • Automated device for asthma monitoring and management (ADAMM)

    • Portable FeNo

  • Majority of studies demonstrate improved inhaler device use, with

    • Less number of activations needed

    • Increases in number of symptom free days

  • Very few studies demonstrate improved disease management.

    • 4 studies (25%) demonstrated improved clinical outcomes.

    • 4 studies (25%) demonstrated no difference between remote management and standard care (N.S.)

    • 8 studies (50%) did not report on clinical improvement (N.A.)

CONCLUSIONS:

  • Telemedicine RPM or RTM in patient with asthma demonstrate a value in decrease inhaler reliance and improved number of symptom free days.

  • However, most studies either did not evaluate the device impact on clinical outcomes or demonstrated no benefit over standard therapy without RPM/RTM.

  • Factors impacting the lack of a significant clinical benefit need to be further assessed.

Erkan Hassan