. 2020 Jun 6;20(8):36. doi: 10.1007/s11882-020-00927-3

Table 2.

Current and emerging technologies in asthma

Technology	Measures	Outcomes in asthma studies	Comments
Wearable technology − Fitbit™ − Apple™ Watch	Fitbit: heart rate (available on most but not all models), steps/day, physical activity (light, moderate and vigorous), sedentary time, sleep efficiency, wake counts Apple Watch: heart rate, EKG, steps/day, physical activity (light, moderate and vigorous), sedentary time	− Fitbit overestimated sleep efficiency and underestimated wake counts compared with actigraphy.¹⁸ − Fitbit-derived sleep quality correlated with PROMIS pediatric asthma impact score.²¹	Corresponding Apps: Apple Watch App on iPhone, Fitbit App on iPhone and Android Pros: portable; commercially available; may be useful when used with other measures such as air quality, lung function and asthma symptoms to digitally phenotype asthma patients Cons: No sleep data available on Apple Watch without 3rd party App Data sharing: Data does not sync to EMR directly but patient can access file and send to provider via mail, secure email, or patient portal.
Electronic monitoring devices (e.g., inhaler sensors ± digital health platform)	Digihaler™: − Inhaler time of inhaler use, peak inspiratory flow rate (PIFR), time to PIFR, inhalation volume and duration. Propeller Health System: − Inhaler sensor: date, time and number of doses taken − Asthma Health Platform App: Location of inhaler use using phone GPS, current weather/pollen counts/air pollution and self-report asthma symptoms/triggers Hailie™ solution: − Inhaler sensor: date, time, number of inhaler actuations and missed doses − Hailie™ App: medication adherence, daily medication reminders Inhaler compliance assessment device: Time of dose, inhaler technique errors	− Greater asthma control^31,38–39 and symptom-free days³³ − Reduction in daily symptoms³¹, rescue medication use^29,32–33, and exacerbations^34,38–39 − Improved medication adherence^36–40 − High patient acceptability of device and digital health platform^36–37.	Corresponding Apps: Digihaler™, Propeller Health, Hailie™. Web-based platform also available for Propeller Health, Hailie™ solution. Pros: portable, high acceptability among patients, improvements in asthma control in those with a digital health platform (e.g., Propeller Health, Hailie™ solution). Cons: Additional efficacy studies of the devices are needed, cost of devices are not always covered by insurance reimbursement Data sharing: Provider platform available to share results (e.g. Digihaler™, Propeller Health, Hailie™ solution), patients may share data from Digihaler™ also via file share.
Mobile-based applications	Self-monitoring of: − Asthma symptoms − Triggers − Medication use	-Improvements in asthma control though low-quality evidence⁴⁵ -Improvements in asthma control in five studies, lung function in two studies and quality of life in three studies⁴⁶	Pros: Acceptable and feasible to use Cons: Vary in quality; data are self-reported, most apps have not been validated; risk of loss of privacy of health information Data sharing: Vary in ability to share with provider, most are up to user to share with provider

Technology

Measures

Outcomes in asthma studies

Comments

Wearable technology

− Fitbit™

− Apple™ Watch

Fitbit: heart rate (available on most but not all models), steps/day, physical activity (light, moderate and vigorous), sedentary time, sleep efficiency, wake counts

Apple Watch: heart rate, EKG, steps/day, physical activity (light, moderate and vigorous), sedentary time

− Fitbit overestimated sleep efficiency and underestimated wake counts compared with actigraphy.¹⁸

− Fitbit-derived sleep quality correlated with PROMIS pediatric asthma impact score.²¹

Corresponding Apps: Apple Watch App on iPhone, Fitbit App on iPhone and Android

Pros: portable; commercially available; may be useful when used with other measures such as air quality, lung function and asthma symptoms to digitally phenotype asthma patients

Cons: No sleep data available on Apple Watch without 3rd party App

Data sharing: Data does not sync to EMR directly but patient can access file and send to provider via mail, secure email, or patient portal.

Electronic monitoring devices (e.g., inhaler sensors ± digital health platform)

Digihaler™:

− Inhaler time of inhaler use, peak inspiratory flow rate (PIFR), time to PIFR, inhalation volume and duration.

Propeller Health System:

− Inhaler sensor: date, time and number of doses taken

− Asthma Health Platform App: Location of inhaler use using phone GPS, current weather/pollen counts/air pollution and self-report asthma symptoms/triggers

Hailie™ solution:

− Inhaler sensor: date, time, number of inhaler actuations and missed doses

− Hailie™ App: medication adherence, daily medication reminders

Inhaler compliance assessment device:

Time of dose, inhaler technique errors

− Greater asthma control^31,38–39 and symptom-free days³³

− Reduction in daily symptoms³¹, rescue medication use^29,32–33, and exacerbations^34,38–39

− Improved medication adherence^36–40

− High patient acceptability of device and digital health platform^36–37.

Corresponding Apps: Digihaler™, Propeller Health, Hailie™. Web-based platform also available for Propeller Health, Hailie™ solution.

Pros: portable, high acceptability among patients, improvements in asthma control in those with a digital health platform (e.g., Propeller Health, Hailie™ solution).

Cons: Additional efficacy studies of the devices are needed, cost of devices are not always covered by insurance reimbursement

Data sharing: Provider platform available to share results (e.g. Digihaler™, Propeller Health, Hailie™ solution), patients may share data from Digihaler™ also via file share.

Mobile-based applications

Self-monitoring of:

− Asthma symptoms

− Triggers

− Medication use

-Improvements in asthma control though low-quality evidence⁴⁵

-Improvements in asthma control in five studies, lung function in two studies and quality of life in three studies⁴⁶

Pros: Acceptable and feasible to use

Cons: Vary in quality; data are self-reported, most apps have not been validated; risk of loss of privacy of health information

Data sharing: Vary in ability to share with provider, most are up to user to share with provider