Aligning Guideline Criteria for Asthma Control with Digitally Collected Data

Abstract

RATIONALE: National Asthma Education and Prevention Program (NAEPP) guidelines focus on assessment of asthma control at office visits to adjust controller therapy. In contrast, electronic medication monitors (EMMs) enable real-time assessment of increased short-acting beta-2 adrenergic (SABA) use for timely remote intervention. We examined whether current guidelines can be applied to EMMs or whether alternative recommendations are needed. METHODS: Using EMMs, SABA use was continuously monitored in 32 participants, 25-65 years of age, with uncontrolled asthma. After 4-weeks, we categorized SABA use as non-regular (as needed for treatment of symptoms) or regular, defined as either daily regardless of symptoms or preemptively before exercise or known allergen exposure. The first week of data (run-in) was excluded. Asthma control status was determined by absolute number of days of SABA use based on NAEPP guidelines (> _3 days/week for at least one week during weeks 2-4) and by relative increase in use (> _1 day/week increase for weeks 3 or 4 from week 2). Fisher's exact test was used for analysis. RESULTS: Of 32 participants, 12.5% (4/32) were regular SABA users. Using the relative definition of asthma control, 3 of 4 regular users had well controlled asthma, while the absolute definition considered all 4 as not well controlled. In non-regular users, there was a marginal relationship between asthma control status between absolute vs. relative definitions (p 5 0.38). CONCLUSIONS: Change in SABA use may predict the need to adjust controller therapy and imminent exacerbation risk. Algorithms are needed to determine both as digital signals are integrated into clinical practice.