Using Tech to Manage High-Risk Asthma in Teens

The same technology that can drive a parent batty in the hands of a teenager just might prove to be the teen’s best friend. Technology has proven to be one of the best ways to help kids with high-risk asthma, according to a Cincinnati Children’s pilot study. Teaming preteens and teens who had poorly managed asthma with the latest tech yielded surprisingly positive results.

“We saw a large decrease in the number of attacks these kids were having,” says Theresa Guilbert, MD, MS, the Cincinnati Children’s pulmonologist who oversaw the two-year program. The study followed 21 students in the Cincinnati Public Schools system. Kids ranged in age from 10 to 17 and attended three schools in areas of the city plagued by high levels of asthma.

The tools used included video teleconferencing with physician asthma specialists, who reviewed the medical aspects of care, and with health psychologist Rochelle Ramsey, PhD.

In addition, each child was given an electronic inhaler monitor. “This device counts how many times the kids use their daily asthma controller or rescue medications,” says Guilbert. It helped doctors evaluate why medications might not be working for a child. “I’m not going to increase the dose of a controller medication if a child is only using it half the time or less,” Guilbert says.

If the health psychologist saw that a child was having trouble using medications, Guilbert says, she helped them problem-solve and build self-management skills.

The final piece of technology used in the study was a smartphone given to each child and programmed to interact with the caps on the medication bottles, enabling the medical staff to see how much medication the kids were using.

If a child wasn’t taking medication regularly, staff could send texts to kids and families with reminders and other adherence messages.  

The overall rate of pediatric asthma in Greater Cincinnati is more than twice the national average and, in some neighborhoods, the rate of hospitalization for asthma is 10 times the national rate.

Partnering with the schools made sense, since many of the kids in the study already used the school-based clinics for their asthma care. Doctors were available to the school staff if needed, but were seldom called on, says Guilbert.

“We were available to the staff if they needed us, but the kids hardly had any asthma attacks during the study. It was rare. We saw a large decrease in the number of attacks these kids were having.”

Guilbert was surprised at the remarkable success of the study. “We had no dropouts, very few missed school visits to date. We counted on 30 percent no-show and we were pleasantly surprised. Our estimated loss of equipment, inhaler caps and cell phones was also a lot less than anticipated. Overall, the study showed that reducing asthma exacerbations with a program like this is feasible.”

She is in the process of writing up the study, which was funded by the Luther and Verizon Foundations, to submit it for publication. She is also applying for an R01 grant to expand the program to 26 Cincinnati public schools.

Guilbert credits the support and teamwork of the school staff for much of the program’s success. “This was truly a team effort – by the principals and staff of the schools, the school nurses and clinics, which are supervised by the Cincinnati Health Department, the families and kids, and the hospital.”

She was particularly gratified that the study outcomes were so positive, given that the students who participated had had poorly controlled asthma, living and attending school in neighborhoods plagued by conditions that exacerbate the illness.

“It did demonstrate that a novel communication-based intervention is feasible in a population with difficult to treat asthma,” Guilbert says. “We saw an impressive decrease in the number of asthma attacks and healthcare utilization. So it’s going to save healthcare costs. And by using technology, we didn’t need to be out in the community all the time, and it was appealing to the kids.”

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