Assessing the technical feasibility of a flexible, integrated Internet-of-things connected for asthma (C4A) system to support self-management: a mixed method study exploring patients and healthcare professionals perspectives

Abstract

Background A connected system with smart devices could transform patient care and empower patients control of their asthma. Objective To explore how a connected-for-asthma system (C4A) with smart devices from multiple companies (smart-inhaler; smart-watch; smart-peak-flow meter, manual digital thermometer during the Coronavirus disease (COVID)-pandemic) could support asthma self-management. Methods In a proof-of-concept mixed-methods study (Winter 2021/2022), we collected data from devices linked via the C4A app enabling patients to self-monitor and share a monitoring summary (in PDF format) with their clinician. Ten patients (range of age/gender, asthma experience, Apple/Android user) via social media, used C4A for a month. We conducted pre/post-interviews with patients, and a single post-interview with an asthma nurse and 3 general practitioners. Thematic analysis, informed by the Unified Theory of Acceptance and Use of Technology was triangulated with descriptive analysis of usage data. Results The system was perceived as “easy” to use. During the study, 7517 data points were collected from 10 patients; monitoring reduced over the month. Patients used devices if they trusted their “accuracy,” and adopted the system to monitor new medication or assess troublesome symptoms. One patient lost contact (because of COVID), 8 wanted to keep using C4A to manage their asthma, though were selective about the most useful devices. Clinicians wanted the report to provide an asthma score/status and reliever usage. Conclusion A connected system could enable flexible digital care by linking data from several devices to support self-management. To promote adoption/adherence, setup has to be simple, and patients need to trust that the devices accurately reflect their condition.

Implementation of digital home monitoring and management of respiratory disease

“…Software applications are typically designed to support a single device -or linked devices from a single company; the registration process is currently unclear on how it applies to systems level connected platforms processing input from multiple sources. Clarification will be needed to enhance implementation towards an interoperable, device-agnostic connected system [60][61][62].…”

“…Linking multiple devices and summarizing data in one common platform for patients/professionals will be an important practical advance, but work on a device-agnostic connected platform is mostly still in the pilot stages [ 60 , 61 ]. Further development is required to ensure the connection process is as simple as ‘plug and play’ to encourage adoption [ 62 ].…”

Home monitoring in asthma: towards digital twins

“…In a pilot randomized controlled trial with 30 adults with asthma, using the system for 3–6 months was associated with better asthma control and quality of life than in the control group [28 ▪▪ ]. Another integrated system, the C4A system (connected-for-asthma system), which consists of smartinhalers, a smart watch, a portable spirometer and a digital thermometer is currently being evaluated [25 ▪ ].…”

“…In Europe, the Copernicus atmospheric monitoring service (https://atmosphere.copernicus.eu) provides continuous data and information on atmospheric composition on a European scale, with developments underway to add information on allergen exposure levels to meteorological parameters and pollutants. With their geolocation features, smartphones and smartwatches allow to link these environmental data to the user's location [25 ▪ ].…”

“…Their acceptability by patients and HCPs is a first challenge [43 ▪ ]. Patient acceptance of digital systems is generally good in studies that have evaluated the use of multiple sensors to monitor asthma [25 ▪ ,31 ▪ ,44 ▪ ]. Asked specifically about a digital twin system for managing their asthma, combining continuous home monitoring via connected objects, automated treatment changes based on artificial intelligence, and an in-person visit once a year to update the algorithms, 56% of the 99 children surveyed in Paris (France) were willing to use the system if it proved as effective as usual care [45 ▪ ] (Fig.…”