Study shows smart inhalers may help manage children’s asthma

Meyonna Cosey often sat on the sidelines in gym class. Many times, she skipped outings with her friends. As a teenager from Chicago she said she frequently felt isolated and lonely because she didn’t know when or where an asthma attack would strike.

“The last time I had an asthma attack, I couldn't talk at all. I was gasping for air; it was just very, very scary,” Meyonna said. “I just want to get better.”

Meyonna wasn’t alone. She and her younger brother, Brandon, had experienced severe asthma for most of their lives, posing a challenge for their mother to know how to best protect them from sudden symptoms that often arise with little or no warning.

“Weather changes, climate changes, small triggers,” said McKayla Kline, their mother. “It can be tiresome as a parent.”

Most children with asthma take two inhaler medications — a daily “controller” medication of corticosteroids to prevent exacerbations and a rescue inhaler for breathing troubles. However, some families struggle to manage multiple medications.

“Often times it's very confusing to families which inhaler is which and what they're supposed to do with them,” said Ruchi Gupta, M.D., a professor of pediatrics at Northwestern University Feinberg School of Medicine and a practicing physician. “As physicians, we are unable to really monitor how patients are using their medications. This limits our ability to support their asthma management. Our goal is to see how we can use technology best to help us improve care for our children with asthma.”

It’s why McKayla enrolled her children in a first-of-its-kind asthma study to test the use of “smart inhalers.” The study is one of more than 20 research projects UnitedHealthcare has organized with leading academic institutions to test and scale “digital therapeutics” to help improve how health care is delivered. Using Bluetooth® technology and mobile apps, the inhaler is able to send real-time data back to parents and medical providers to help monitor the usage.

More than 250 children between 4 and 17 years old with moderate to severe asthma and their caregivers participated in the “Improving Technology-Assisted Recording of Asthma Control in Children” (iTRACC) year-long study. Each were given a sensor-based inhaler and were assessed on multiple factors, including caregiver quality of life, children’s adherence, asthma control and the need for asthma-related health care interventions.

For example, if a child enrolled in the study missed four days in a row of their prescribed medication, or if they used a rescue inhaler more than four times in one day, the connected device would send an automatic alert to the family’s health care provider to intervene.

The results of the year-long study showed the use of sensor-based inhaler monitoring may help improve asthma symptom control and caregiver quality of life.

Children participating in the study were evaluated based on an Asthma Control Test questionnaire, where they measured their asthma symptom control on a scale from 0 (poor control) to 27 (well-controlled). Scores of 19 and below indicated uncontrolled asthma. Average scores saw a significant increase over the course of the study, with the greatest improvements among non-Hispanic Black participants.

Black children in Chicago have almost double the rates of asthma compared to white children, Dr. Gupta said. The disease is higher among children who live in poverty or urban environments, where access to primary care is often limited. Asthma is one of the top reasons kids are hospitalized, admitted to emergency rooms or are absent from school, Dr. Gupta added.

Caregivers who participated in the study were assessed based on a Pediatric Asthma Caregiver’s Quality of Life questionnaire, measuring how the sensor-based monitoring adherence affected their day-to-day involvement. The scale ranged from one (severely impairing their quality of life) to seven (unimpaired or not at all limited).  

Caregivers reported improvement to their quality of life after the first month of the study, which was sustained through the year-long trial, due to ease of asthma management.

In addition, by eliminating some of the guesswork for caregivers, as data could be analyzed by providers in real-time before symptoms worsened, the frequency of asthma attacks saw a significant decrease.

In Chicago, the prevalence of asthma in children under 18 is 14%, which is higher than the national rate of 8-10%. In specific neighborhoods and racial groups, asthma rates can soar up to 44% of children, according to Dr. Gupta’s research published in the Journal of Allergy and Clinical Immunology.

UnitedHealthcare organized the study in collaboration with Dr. Gupta, Northwestern University and five Chicago-area pediatric clinics as part of its commitment to helping kids stay healthy through improved management of chronic conditions.

For Dr. Deneen Vojta, a pediatrician and senior vice president of innovation, research and development for UnitedHealth Group, programs like this can help identify barriers to care. It may also help doctors better understand how connected devices may be used to improve treatment plans for people with chronic conditions, such as asthma.

“The emerging use of digital therapeutics – enabled by wearables and access to near real-time data for patients and care providers – is helping to prevent, detect and intercept disease,” said Dr. Vojta. “By working with leading academic institutions, medical device makers and pharmaceutical companies, we are taking promising ideas and accelerating their availability to improve the health of more Americans.” 

As for Meyonna, she’s a 10th grader who now has much more confidence that she can participate in the activities she loves, including dancing and painting.

“I feel amazing; I'm just happy that I can do a lot more than I could,” she said. “Asthma's not going to keep me down forever, so I just keep that positive mindset.”