Automated Device for Asthma Monitoring
Condition: Asthma
MeSH terms: Asthma
Study type: Observational

Summary: 
      This study will examine an innovative strategy to monitor asthma symptoms by using existing
      technology to develop a non-invasive device for monitoring asthma symptoms in adolescents.
      Using an iPod as a platform, and current sound data analysis techniques, a prototype device
      will be developed that will directly monitor the chosen parameters of asthma symptoms,
      including wheezing, coughing and activity levels. This small non-invasive device will be
      continuously carried by or placed in close proximity to the adolescent on a daily basis. It
      is hypothesized that such a device would be acceptable to adolescents and would lend accuracy
      and objectivity to symptom assessment; something that existing monitoring strategies have yet
      to achieve. It will also stimulate the adolescents' partnership in asthma self-monitoring and
      ultimately lead to effective asthma management.
    

Detailed description: 
      Prior research has generated compelling evidence that programs promoting self-management can
      reduce morbidity and improve asthma outcomes in children. Successful asthma management
      strategies require patients' active commitment to engage in care processes by establishing
      self-monitoring routines. Adequate self-monitoring of asthma symptoms is considered to be the
      cornerstone of appropriate asthma management leading to fewer cases of asthma exacerbation
      and acute care visits as well as better functional outcomes and higher quality of life in
      children and adolescents. Symptom monitoring informs patient decisions to initiate necessary
      self-management behaviors (e.g., adjust medication, alter activity level, alter the
      surrounding environment or seek medical assistance) as well as the providers' decisions
      related to an appropriate treatment course such as step up, no change or step down therapy.
      Thus, current guidelines by National Heart, Lung, and Blood Institute (NHLBI) Expert Panel
      Review 3 (EPR3) highlight the importance of ongoing symptom monitoring.

      Studies of children have raised concerns about adequacy and effectiveness of current methods
      of asthma self-monitoring including symptom-based and peak expiratory flow (PEF) monitoring.
      Symptom-based monitoring relies on the individual's symptom perception which is subjective
      and influenced by a variety of factors such as the patient's emotional status, social
      influences (e.g, family, peers) and previous experiences with symptoms. Thus, the accuracy
      and objectivity of this monitoring method is uncertain. As an objective approach, PEF
      monitoring has been encouraged, yet the efficacy of this method has also been a subject of
      ongoing debate in the literature. Poor adherence and inadequate technique further diminish
      the clinical usefulness of PEF monitoring. Thus, the uncertainty of current monitoring
      strategies underscores the imperative of an alternative symptom monitoring strategy that
      addresses the issues of accuracy and objectivity of symptom assessment.

      Adolescence is an important period for consolidating and establishing self-management of and
      adjustment to chronic health conditions. Yet an array of developmental challenges including
      the desire for normalcy and peer approval, feelings of invulnerability and emerging
      independence undermine adolescents' motivation and behaviors to engage in self-management and
      present particular difficulties in achieving optimal asthma control in adolescents with
      asthma. Parents become less able to manage asthma as children reach adolescence and many
      researchers and clinicians have reported similar difficulties in managing asthma in
      adolescents primarily due to inadequate adherence and counterproductive behaviors. Thus,
      clinicians face serious challenges in providing optimal management for adolescents with
      asthma primarily due to difficulties in soliciting patients' active partnership in asthma
      management with sustainable and reliable symptom monitoring routines. Accurate symptom
      monitoring by patients is the most fundamental antecedent to effective asthma management, yet
      existing monitoring strategies have not been conducive to adolescents' cooperation or yielded
      accurate or clinically useful information. Having recognized these limitations, this study
      will examine an innovative strategy to monitor asthma symptoms that stimulates adolescents'
      partnership and ultimately leads to effective asthma management.

      The device will directly monitor the chosen parameters of asthma symptoms, including
      wheezing, coughing and activity levels. A mobile phone will be employed as a platform for
      processing, analyzing and storing data transmitted from a microphone and a wireless
      accelerometer. This new approach is developmentally appropriate, given adolescents' affinity
      for technology and its capacity to address adolescents' need for maintaining normalcy while
      allowing continuous asthma monitoring during real-life situations. The device involves
      biomedical engineering techniques enabling automatic sound and activity recording, analysis,
      feedback, and storage function. A mobile phone will be employed as a platform for processing,
      analyzing and storing data transmitted from a microphone and a wireless accelerometer. This
      technology will automate daily symptom monitoring with minimal intrusiveness and maximum
      accuracy, thereby reducing the risk of inappropriate treatment and ameliorating
      asthma-related disability. Due to its foreseen safety, noninvasiveness, objectivity,
      convenience, user-friendliness, and cost containment, the approach can greatly enhance asthma
      management by adolescents and health care providers. This device has the potential to bring
      about patient behavior changes such as avoiding triggers and adjusting medications as the
      device will provide the opportunity for in-time review of symptoms.
    

Intervention name(s): Automated Device for Asthma Monitoring (ADAM)
Intervention type(s): Device
Intervention description(s): Both groups of adolescents (asthma/non-asthma)wore a prototype ADAM device for 7 days as they went about their usual daily activities. At night, the device continued to monitor symptoms as it was placed in close proximity to the adolescent's head during sleep. The asthma group answered survey questions about the status of their symptoms and their usage of asthma medication every morning and every evening- entering their answers directly onto the monitoring device.
Observational model: Case-Control
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Adolescents between the ages of 13-17 who received care at Strong Memorial Hospital,
        Rochester NY.
      
Keywords: Asthma; Adolescents; Self-monitoring; Quality of life; Biomedical device; Symptom monitoring; Self-management