The first group of asthma patients, who received only treatment, without using the smartphone application, included 54 patients, 30 males and 24 females, aged between 18 and 72 years, mean age 38.59 (±17.64) years, 95% CI (33.78; 43.41).
At the first evaluation (T1), most of these patients (85.18%) used an emergency inhaler. In addition, almost a half of the patients (40.74%) presented severe exacerbations which required hospitalization, while 35.18% of the patients presented mild to moderate exacerbations, without hospitalization. The median ACT score, at the first evaluation, was 18.00 (17.00–19.00).
At the second evaluation (T2), slightly lesser patients (74.07%) used the emergency inhaler. No patient presented severe exacerbations requiring hospitalization, while more patients presented mild to moderate exacerbations (46.3%). The ACT score has significantly improved to 19.00 (17.00–19.00) comparing to the initial evaluation, Mann-Whitney U test, p < 0.001. At the third evaluation, the number of inhalers used has reduced to 38.88%, while the ACT score presented significantly higher values than the previous evaluation, 20.00 (20.00–22.00), Mann-Whitney U test, p < 0.001. On the contrary, when considering the evaluations at 9 (T4) and 12 months (T5), we observed that the ACT score did not significantly improved when comparing to the previous evaluations, Mann-Whitney U test, p = 0.188, and, Mann-Whitney U test, p = 0.764, respectively, but the number of patients hospitalized for severe exacerbation at T5 was higher. The complete description of the results observed at the evaluations of the first group is presented in Table 1.
Table 1
Description of the results observed at the evaluation of the asthma patients included in the first group (N = 54).
Evaluation time | ACT score(a) | Emergency inhaler used(b) | Exacerbations(b) |
Required hospitalization | Did not require hospitalization |
T1 | 18.00 (17.00–19.00) | 46 (85.18%) | 22 (40.74%) | 19 (35.18%) |
T2 | 19.00 (19.00–20.00) | 40 (74.07%) | 0 (0%) | 25 (46.3%) |
T3 | 20.00 (20.00–22.00) | 21 (38.88%) | 1 (1.85%) | 7 (12.96%) |
T4 | 21.00 (20.00–22.00) | 14 (25.92) | 1 (1.85%) | 8 (14.81%) |
T5 | 21.00 (20.00–22.00) | 17 (31.48%) | 5 (9.26%) | 8 (14.81%) |
Abbreviations: T1 = initial evaluation time, T2 = evaluation at 3 months; T3 = evaluation at 6 months; T4 = evaluation at 9 months; T5 = evaluation at 12 months. ACT = Asthma Control Test. |
(a) Values are presented as median (percentile 25% - percentile 75%). |
(b) Values are presented as absolute frequency (percentage). |
The second group of asthma patients who used the mobile application in addition to their treatment, included 21 male and 18 female patients, aged between 18 and 66 years, mean age 36.87 (±15.44) years, 95% CI (31.87; 41.88).
At the first evaluation (T1), all the patients used an emergency inhaler. More than a half of the patients (58.97%) presented severe exacerbations requiring hospitalization, while 41.03% of the patients presented exacerbations which did not require hospitalization. The median ACT score was 19.00 (18.00–20.00).
When considering the second evaluation (T2), only 23.08% of the patients (23.08%) were still using an emergency inhaler. In addition, we observed that no patient presented exacerbations requiring hospitalization, while also lesser patients presented mild to moderate exacerbations (10.26%). The ACT score has significantly improved to 21.00 (20.00–22.00) comparing to the initial evaluation, Mann-Whitney U test, p < 0.001. At the third evaluation, the number of inhalers used was significantly reduced while the ACT score presented significantly higher values than the previous evaluation, mean score 23 (23.00–24.00), Mann-Whitney U test, p < 0.001. At the evaluations at 9 and 12 months, the ACT score maintained the same value as in T3 and there was no severe exacerbation. The complete description of the results observed at the evaluation of the second group is presented in Table 2.
Table 2
Description of the results observed at the evaluation of the second group (N = 39).
Evaluation time | ACT score(a) | Emergency inhaler used(b) | Exacerbations(b) |
Required hospitalization | Did not require hospitalization |
T1 | 19.00 (18.00–20.00) | 39 (100%) | 23 (58.97%) | 16 (41.03%) |
T2 | 21.00 (20.00–22.00) | 9 (23.08%) | 0 (0%) | 4 (10.26%) |
T3 | 23.00 (23.00–24.00) | 4 (10.26%) | 0 (0%) | 5 (12.82%) |
T4 | 23.00 (23.00–24.00) | 1 (2.56%) | 0 (0%) | 1 (2.56%) |
T5 | 23.00 (23.00–24.00) | 4 (10.26%) | 0 (0%) | 4 (10.25%) |
Abbreviations: T1 = initial evaluation time, T2 = evaluation at 3 months; T3 = evaluation at 6 months; T4 = evaluation at 9 months; T5 = evaluation at 12 months. ACT = Asthma Control Test. |
(a) Values are presented as median (percentile 25% - percentile 75%). |
(b) Values are presented as absolute frequency (percentage). |
When comparing the results observed between the two groups, at the first evaluation, there were no significant differences of the ACT score, Mann-Whitney U test, p = 0.495. On the contrary, at T2 the ACT score was significantly higher for patients that used the mobile application in addition to treatment than for the patients using the treatment alone, Mann-Whitney U test, p < 0.001. Similarly, the same significant difference of ACT score was maintained between the two groups when considering the evaluations at 6 months (T3), 9 months (T4), and 12 months (T5) (Fig. 5).
Figure 5. The ACT score of the group using the only treatment (Group 1) and the group using both the treatment and mobile application (Group 2). (T1 = initial evaluation time, T2 = evaluation at 3 months; T3 = evaluation at 6 months; T4 = evaluation at 9 months; T5 = evaluation at 12 months. ACT = Asthma Control Test).
At the same time, we observed significant differences between the ACT score of the group using the treatment and mobile application and the group using only the treatment stratified by gender.
Regarding the exacerbation rate, at the first evaluation, a higher proportion of patients not using the application presented exacerbations compared with the group using the application, irrespective of hospitalization requiring (58.97% vs 40.74%, chi-square test, X2(1) = 3.105, p = 0.081, for severe exacerbation; 41.03% vs 35.18%, chi-square test, X2(1) = 0.329, p = 0.566, for mild to moderate exacerbation). In addition, at the second evaluation, we did not observe exacerbations requiring hospitalization in any of the two groups, while the number of exacerbations which did not require hospitalization was significantly higher in case of the first group, when comparing to the second group, 46.3% vs 10.26%, X2(1) = 13.71, p < 0.001.
Moreover, at the third evaluation, we observed one exacerbation requiring hospitalization in the first group and still zero in the second group, while the number of exacerbations which did not require hospitalization was the same in both groups. When considering the other evaluations, we observed that the number of exacerbations without requiring hospitalization was significantly lower in case of the second group for the fourth and insignificantly lower for the fifth evaluations, 14.81% vs. 2.56% (Fisher exact test, p = 0.04) and 14.81% vs 10.25% (Fisher exact test, p = 0.748), respectively. The number of exacerbations requiring hospitalization was still zero in the second group, while in the first group we observed a significant higher number of exacerbations for the fifth evaluation, 9.26% (Fisher exact test, p = 0.031).