Utilization and Outcomes Associated with Mobile-Based Asthma Action Plans Compared to Paper Asthma Action Plans Among Adolescents

Rationale: Adolescent asthmatics are at increased risk of poor outcomes. We hypothesized that adolescents utilizing mobile-based asthma action plans (AAP) would have more frequent AAP use and improved outcomes compared to adolescents utilizing paper AAPs.

Methods: We conducted a randomized, controlled trial with adolescents with persistent asthma to compare utilization and outcomes associated with mobile-based vs. paper AAPs.  After randomization, participants were instructed to utilize their respective AAPs for medication instructions and to record peak flow or asthma symptoms and medication use daily for 6-months. AAP utilization was measured electronically for mobile AAP users and via mail-in diaries for paper AAP users. Asthma symptoms, asthma control test (ACT) and self-efficacy scores were compared pre/post the 6-month intervention for both groups.                                                                     

Results: Of the 34 participants, median age was15.4 years, African-American 62%, state-issued insurance 71%. Median days of AAP utilization were 4.36 and 7.00 days/week for the mobile and paper groups, respectively.  Adolescents in the mobile group accessed the AAP 12.17 times/week (median). There were no changes in ACT and self-efficacy scores between groups when all participants were included in analysis.  However, for the 15 adolescents with uncontrolled asthma (baseline ACT ≤19), there was a clinically important improvement in ACT for the mobile group (pre 11, post 20) but not the paper group (pre 17, post 17) [p=0.06]. The mobile group reported significantly improved shortness of breath [p=0.003] and nocturnal symptoms [p=0.03] post-intervention.

Conclusions: Although utilized less frequently than paper AAPs, mobile-based AAPs demonstrated evidence of improved outcomes for adolescents with uncontrolled asthma.