Tracking App Helps Children Control Asthma Better

There is now an app that allows parents and doctors to monitor a child's asthma and it is having a big impact on managing the disease. When families monitored symptoms with eAsthma Tracker and adjusted care accordingly, children had better asthma control and made fewer visits to the emergency department. Using the app also meant that children missed fewer days of school and parents took fewer days off work, improving quality of life. "It's exciting to see that using an effective app can not only help improve the lives of children with asthma and their parents, but also allow their providers to give optimal care," says the study's lead author and University of Utah Health professor of pediatrics Flory Nkoy, MD, MS, MPH. He and his team created the app and carried out the research along with collaborators at Intermountain Healthcare and Parent Partners in Salt Lake City.

Scientists and physicians designed eAsthma Tracker as a way to continually monitor a child's disease. Keeping asthma in check can be particularly tricky. Despite effective treatments, an attack can come seemingly without warning and up to 40 percent of children hospitalized with asthma wind up back in the hospital within a year. A major contributing factor is that signs that precede an attack often go unnoticed. “Asthma care is typically reactive, focusing on treating recurrent attacks,” says the study's senior author and U of U Health hospitalist Bryan Stone, MD, MS. “While most children with asthma show signs days to weeks before an attack, parents can easily miss these changes. eAsthma Tracker allows for monitoring at home, opening an opportunity to observe worsening signs and intervene in time to prevent a flare-up.”

The app sends parents and doctors data in real-time, and triggers an automated alert when a child's asthma is acting up. When that happens, the app prompts parents to make an appointment with the child's doctor. A doctor receiving an alert may decide to proactively call parents to determine how to address the issue. "Parents love the idea that they can see how their child is doing and that their doctor is on the other end of the app and working with them," Stone added.

Improving Asthma Control

More than 300 children and parents at 11 clinics throughout Utah enrolled in the study – published in the journal Pediatrics – and designed to determine whether the app improved patient outcomes. Families who use eAsthma Tracker fill out a brief weekly online survey based on a standard assessment called the Asthma Control Test. The app assigns a score reflecting whether asthma is impeding the child's daily activities and how often they're using medication to control symptoms. It then issues recommendations dependent on being categorized as severe (red zone), under control (green zone) or approaching severe (yellow zone).  

Researchers found that children who used the app improved their asthma control; made significantly fewer visits to the emergency department and hospital; significantly reduced oral steroid use - a surrogate measure for asthma attacks - missed 60 percent fewer days of school, and had an improved quality of life. In addition, their parents missed 70 parent fewer days of work. Children and parents showed improvements in all measurements three months after starting to use the app, and the benefits persisted 12 months later.

The investigators also compared outcomes from children who used eAsthma Tracker with outcomes from children who did not use the app. Results from this part of the study showed that children who used the app made 60 percent fewer visits to the emergency department and hospital, and had a 35 percent reduced use of oral steroids. The main limitation of the study was the lack of a control group pulled from the same clinics that study participants were recruited from. Although design of this part of the research was not optimal, the reasoning behind the omission was intentional. Based on promising results from a pilot investigation, the parent and community stakeholders that helped design the research recommended against withholding the app from willing participants. Nkoy and Stone are now working with the university's Center for Technology & Venture Commercialization to conduct market validation and develop a commercialization strategy to expand to other hospital systems. "We are optimistic that spread of eAsthma Tracker can significantly improve asthma care and reduce asthma related healthcare costs," says Nkoy.

Wearing Tech Can Track Stomach Activity

Researchers have been formulating technology that will allow the stomach to be monitored in detail by a non-invasive system. The mechanisms that are used include something similar to an electrocardiogram but instead it is formulated specifically for the GI tract. This monitoring will be done via electrical activity that is read through the specific parts of the apparatus. One specific purpose for such technology is the ability to properly monitor stomach activity outside of a clinical setting which can be very expensive and lack practicality.

The researchers hoped that their research and technology would help spark a new form or kind of medicine. When the GI tract is showing rhythms that are abnormal or troubling during digestion, stress or other situations, it can be beneficial to have immediate and accurate readings. This can positively impact things like diagnoses and treatment. Due to the utter dynamics of the GI tract, getting accurate readings can be very difficult, especially because the GI tract is constantly changing. Whether from the food you eat, what you drink, stress levels, digestion patterns and so on, there is so much that can change very quickly. “This will help us determine if the stomach is functioning properly during meals and – most importantly – when patients are experiencing symptoms such as nausea and belly pain,” says Dr. David Kunkel, one of the paper's co-authors and a gastroenterologist at UC San Diego Health. “There was a common goal that specific engineers and physicians had when they worked together to construct this technology. One of the greatest issues and challenges was properly forming an algorithm that could both recognize and boost the stomach's signal mechanisms. Things like outside sounds can sometimes be distracting or throw other readings off. This is because the electrical signals that come from the midsection are actually 10 times weaker sonically than those of the heart. This means that they can naturally be a bit more difficult to detect.”

The Gadget Will Catch It

The developed device is made of top-of-the-line electrodes. The battery is encased in a 3D printed box that is placed right over the abdominal muscles of an individual’s stomach. The first to test this new technology was a small group of children from a pediatric hospital in San Diego, California. Eleven of them were given the device to wear and certain data was gained throughout the research process. “I have been practicing pediatric gastroenterology and taking care of patients for 20 years,” says researcher Dr. Hayat Mousa. “The only method to assess gastrointestinal motility involves placing motility catheters in the GI tracts while kids are sedated or under general anesthesia. It has been a long journey discussing the benefits of doing such an invasive procedure with my patients and their families. My challenge has always been finding a test that offers a non-invasive assessment of the enteric nervous system and its connections with brain function.”

This technology has successfully done that. The data is gathered and stored in an app that can be checked and monitored via a smart phone. Things like sleep, meals and other activities can be logged in the app as well. There are also goals that can be logged and data readings can be updated in real time. If there are specific problems with the GI tract, such as a delayed emptying of the stomach, this gadget will catch it.

About The Author:

Lisa S. Jones is a certified nurse, nutritionist, fitness coach and health expert. Her training credentials include a B.Sc. in Nursing from California State University in 2013 and Youth Nutrition Specialist Certification from the American Fitness Professionals and Associates in 2015. In 2017, she also received Holistic Nutrition Certification from the American Fitness Professionals and Associates.


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