The Impact of QIoT Connected Asthma Solution on Asthma Management

A Comprehensive Research Study

Justification

5.4 million people in the UK currently live with asthma, with 200,000 of those people diagnosed as having severe or difficult-to-treat asthma.
Asthma is a complex disease and there are multiple triggers both environmental and psychological, which can cause inflammation or allergic reaction within the airways resulting in an attack.
These triggers are unique to each patient and their exposure can change depending on the season, the patient’s location, the weather and personal circumstances.
Increasingly, the impact of air quality is being identified as affecting asthma.
Lack of information for patient self-management, imperfect adherence in taking medication, and reliance on fallible patient memory at doctors’ surgeries, result in sub-optimal asthma control.
Overall, this leads to an increase in oral corticosteroid use, acute exacerbations, hospital admissions and mortality.

Ultimately, lack of real and timely information results in greater costs to the health care system, with patients who have acute exacerbations of asthma costing the NHS 3.5 times as much as those who do not. A 2017 report published by Asthma UK noted 2/3 of all asthma attacks and death are preventable if only patient-appropriate medication were taken as and when prescribed.

Patients with asthma can be managed effectively using a personalised asthma care plan, with studies showing that patients with a written plan are 4 times less likely to be hospitalised due to an asthma attack. Technology solutions help to support the patient in self-managing their own symptoms in between clinic and alert them and their physician or carer of the need for urgent medical intervention.

Health care is becoming more digitalised, and a few innovative technologies have been developed, such as solutions and telehealth services providing virtual asthma plans on patients’ phones. These technologies are interactive, providing healthcare professionals with real-time data they can use to develop more personalised asthma plans, provide timely intervention in the case of deterioration, and make care more patient-centric (1,9,10).

Studies have demonstrated the effectiveness of technologies in improving adherence to medication via regular digital feedback and education. This reaffirms good inhaler technique and improves self-management by providing information on overall asthma management including adherence, peak flow readings, stress and activity or lack thereof, and environmental triggers such as pollen levels or pollution, so patients can avoid them. (1, 9, 11, 12).

Technology allows healthcare professionals and patients to remain connected, which is particularly important in situations like the COVID-19 pandemic; patients with severe asthma need to self-isolate but still have the same high healthcare needs and requirements.

Asthma care professionals need a digital solution to monitor their patients and remain connected with them between clinic appointments. They need a system that also helps to improve patient attendance at clinics, decreases hospital admissions and GP contacts as well as aids the patient in managing their symptoms.

Healthcare organisations can utilise technology to support their patient asthma care while reducing the costs time and resources to support asthma patients. The NHS spends over £1 Billion annually treating asthma patients. Supporting asthma patients to self-manage their disease to the point of intervention with the aid of digital technology would help to decrease hospitalisations and deaths.

Aims and Objectives:

Primary aim

Assessing and evaluating the QIoT Asthma Solution effectiveness in Improving Asthma Control.

Secondary aim

Evaluating the Impact of the QIoT Asthma Solution on Asthma Management.
Enhancing Asthma Management with the QIoT Asthma Solution.
Improving Asthma Control with the QIoT Asthma Solution.
Monitor adherence to medication using the QIoT Asthma Solution.

Tertiary aim

Investigating the QIoT Asthma solution’s clinical utility for Asthma Management.
What effect the QIoT Asthma solution has on patient self-manage?
Is the QIoT Asthma solution easy to use and understand?
Does the QIoT Asthma solution support increased levels of asthma education?
Can the data from the QIOT Asthma solution help to reduce cost, time, and resources for the NHS?

Study design

A single centre, prospective, service evaluation, feasibility study of the use of the solution from QIoT in aiding the management and self-care of patients over the age of 18 who attend asthma clinics.
Patients will receive ongoing best medical care for their asthma with the addition of the QIoT smartphone solution.
Patients will use the solution for 3 months.
QIoT staff will remotely access the patient’s data using the online portal to ensure the data is twinned from the solution in real-time to the physician-only portal reports.
No additional laboratory samples will be collected, and no additional therapeutic interventions will be administered.

Eligibility criteria

Participants must be > 18 years of age.
Participants must have a diagnosis of asthma and attend an asthma clinic.
Participants must not have legally defined incapacity and should normally be able to give written informed consent.
Participants must have a smartphone.

Exclusion criteria

Participant unable to use the solution due to a disability such as visual impairment.
Participant does not understand English.

Ethical review

QIoT will ensure that this study is conducted in accordance with the principles of the Declaration of Helsinki (Seoul 2008) and the terms of ethical approval. QIoT will ensure that the study conforms with all research-relevant local, Scottish and UK regulations and procedures and with the ICH Guidelines for Good Clinical Practice (July 1996) and will be reported in accordance with the STROBE guidelines.
Participants will be identified by Elaine Cunningham from Laurens Law Asthma Campaign; they will then be approached by a member of the QIoT team to explain the project verbally and to give written information.
It will be made clear to the participant that their participation is voluntary, they are free to refuse or withdraw their participation and that at no point in the trial period should they use the data from the trial to diagnose their illness, it will be stressed that doctor medical advice will always be followed regardless of what the data shows on the trial.
Frank Quinn from QIoT has been identified as having access to coded information linking patients with data, any information available to third parties publication will be anonymised. He will be responsible for monitoring activities, or if there are problems with oversight/monitoring procedures.
He will be responsible for the archiving of all study documents, patient data and information and ensure the time retained and storage location meets relevant legal and statutory requirements.

Consent

The potential participant will be informed about the study by Frank Quinn, a trained member of the study team who will provide a verbal and written explanation of the study.
Participants will be given a patient information sheet at the time of discussing the study and will be given at least 24 hours to consider participation.
If the patient is willing to participate in the study written consent will be documented.
Individual consent is required for each participant, and they must have the capacity to be included in the study.
Assessment of capacity will ensure that the participant:
Understands the purpose and nature of the research.
Understands what participation in the research involves and the potential benefits and risks.
Understands alternatives and the voluntary nature of involvement, with no consequences to their routine clinical care.
Is able to retain and weigh up the information and come to their own choice with regards to participation and be able to communicate this so verbal consent can be documented.
If the patient lacks capacity or develops a lack of capacity during the study, they will be excluded.
Consent forms will be safely filed and kept in a security access area in the principal investigator’s office.
Withdrawal of consent may occur at any stage prior to Imaging. The participant will not have to give a reason for refusal of consent.

Data management and confidentiality

All data collected from study participants will be kept securely and will only be accessible by the study team.
Consent forms will be safely filed and kept in a security access area in the principal investigator’s office.
All reported study data will be anonymized, and participants will not be identifiable in publication.
The patient data entered and stored on the solution will be stored on the QIoT cloud portal with data backed up on an additional server. QIoT does not have access to this additional data and only holds a unique number for all accounts but no identifiable information.
Patients/health care providers can access the patient’s records via a password-protected portal which will only be accessed by members of the study team.

Publication and dissemination policy

Data obtained in this study will be published in specific related journals. It may also be disseminated at national and international conferences by members of the research team in the form of posters and oral presentations. In addition, data obtained in this study will be used in future grant applications to continue this research.

Proposed time line

Patient recruitment – 4th to 31st January 2023
Data collection – 10th February for 3 months.
Data analysis – 15th May 2023
The types and methods of data collection and calculations in the trial were based on extensive conversations and meetings with the respiratory team at NHS Highland. Quantitative data regarding symptom control, peak flow testing, trigger awareness, patient education, self-management behaviours, adherence to medication and healthcare utilisation were collected through surveys and solution-generated reports.

Funding

This trial and the solution development were partly funded by private funds from QIoT Ltd, Innovate UK (IUK) and Scottish Enterprise SE Smart Grant – June 2020 and Jan 2022.

The QIoT Connected Asthma Solution – Trial Results:

Abstract

This research study examines the effectiveness of the QIoT Connected Asthma solution in improving asthma management and patient outcomes. The study investigates various aspects of asthma control, self-management, trigger awareness, and the utilisation of digital tools in healthcare. The findings demonstrate the positive impact of the QIoT solution on asthma management, highlighting statistically significant improvements in symptom control, peak flow testing, trigger awareness, patient education, self-management behaviours, and healthcare utilisation of the data when guiding asthma management plans.

Introduction

Asthma is a chronic respiratory condition affecting millions worldwide. Achieving optimal asthma control and enhancing patient self-management are crucial for reducing symptoms, preventing exacerbations, and improving quality of life. Digital health interventions, such as mobile applications, have shown the potential in supporting asthma management. This study aims to evaluate the effectiveness of the QIoT solution in addressing these needs.

Methodology

A sample of asthma patients (n=20) was recruited for a three-month trial period, during which they utilised the QIoT solution for daily asthma management. Quantitative data regarding symptom control, peak flow testing, trigger awareness, patient education, self-management behaviours, adherence to medication and healthcare utilisation were collected through surveys and solution-generated reports.

Results:

Symptom Control:

Medication Adherence: Before using the solution, all participants (100%) reported experiencing daily asthma symptoms. After using the solution for three months, significant improvements in symptom control were observed:
40% of participants reported being symptom-free for six or more days, indicating a substantial reduction in asthma symptoms.
30% experienced four or more symptom-free days, demonstrating a notable increase in the number of symptom-free periods.
20% had two or more days with any symptoms, indicating a decrease in the frequency of symptoms.
10% reported no significant change in symptoms, suggesting the solution may have a varied impact on symptom control.
Peak Flow Testing: Prior to using the solution, 70% of participants did not complete daily peak flow tests, which are crucial for monitoring lung function. However, after using the solution, 60% of users consistently completed two peak flow tests per day, indicating improved engagement and adherence to monitoring their asthma condition.
Asthma Zone Management: A significant majority (70%) of users found the instant calculation of each peak flow test result against their baseline number and the display of corresponding zones highly valuable in effectively managing their asthma zones. This feature enables users to identify their current asthma zone and take appropriate actions to maintain control, leading to better overall asthma management.
Trigger Awareness: During the trial, 70% of participants reported increased overall awareness of asthma triggers. Additionally, 50% noted learning new aspects of their asthma management through flagged triggers during the trial, resulting in better asthma control. The solution’s ability to identify and notify users about potential triggers empowered them to proactively avoid or mitigate triggers, leading to a reduction in asthma symptoms and improved health outcomes.

Self-Management Behaviours:

Daily Notifications: All participants (100%) agreed that daily notifications from the solution increased their levels of self-management compared to before the trial. The regular reminders and alerts provided by the solution help users stay on track with their asthma management routine, such as taking medication, completing peak flow tests, monitoring symptoms, and avoiding triggers, resulting in improved self-care and healthier outcomes.
Inhaler Awareness: 88.9% of participants became more aware of when to take their inhalers, indicating improved adherence to medication usage. Proper inhaler usage plays a vital role in managing asthma symptoms and preventing exacerbations. Increased inhaler awareness fosters a better understanding of medication schedules and improves treatment efficacy.
Doctor Visits: 55.6% of participants visited the doctor less frequently, demonstrating increased confidence in asthma management supported by the solution. By enhancing self-management skills and providing real-time data on asthma control, the solution enables patients to better monitor and address their condition, reducing the need for frequent medical consultations and promoting more efficient healthcare utilisation.

Healthcare Utilization:

Emergency Events: During the trial, 66.7% of participants did not experience any emergency events requiring hospitalisation, indicating a reduction in severe asthma exacerbations. The solution’s impact on asthma control and trigger awareness likely contributed to preventing acute episodes and reducing the need for emergency medical interventions.
Medication Ordering: 44.4% of participants ordered more inhaler medication, indicating improved adherence to medication regimens. Increased medication ordering suggests that participants recognized the importance of consistent medication use and took proactive steps to ensure an adequate supply, resulting in better asthma control and reduced risks of exacerbations.
Asthma Clinic Appointments: 77.8% expressed a willingness to attend all asthma clinic appointments, emphasizing the solution’s impact on discipline and engagement. By empowering patients with personalised data and self-management tools, the solution fosters a sense of responsibility and active participation in asthma management, leading to improved patient engagement and more effective utilisation of healthcare resources.

Patient Education:

Asthma Control Test (ACT) Quiz: 90% of participants agreed that the ACT increased their understanding and management of daily asthma. The quiz serves as an educational tool, helping users assess their asthma control knowledge and providing valuable insights into their condition. By enhancing patient education, the solution promotes informed decision-making and empowers individuals to take a proactive role in their asthma management.
ACT Quiz and Scoring System: 100% of participants found the quiz and scoring system effective in engaging them to think about their asthma management. The interactive nature of the quiz and scoring system encourages participants to reflect on their asthma management and control, identify areas for improvement, and make informed choices regarding their self-management behaviours. This increased engagement fosters a deeper understanding of asthma and empowers patients to make healthier decisions.

Fitness and Stress Management:

Fitness and Stress Improvement: 80% of participants reported improvements in fitness and stress management, positively impacting their asthma triggers. Regular physical activity and effective stress management have been shown to reduce the likelihood of asthma exacerbations. The solution’s impact on fitness and stress management suggests that it contributes to overall asthma control and improved health outcomes.
Improved Fitness Levels: 44% of participants agreed that their fitness levels had improved. By promoting physical activity and providing tools for monitoring and managing stress, the solution helps individuals maintain a healthy lifestyle and reduce the impact of asthma triggers related to fitness and stress. Improved fitness levels can contribute to better lung function and overall asthma control.

Solution Features:

Notes Section: 80% of participants found the notes section helpful for recording incidents and managing asthma triggers. The ability to record and track asthma-related incidents, symptoms, and triggers allows users to identify patterns and make informed adjustments to their management plans. This feature facilitates personalized asthma care and empowers patients to take control of their condition.
On Solution Report Section: 77.8% utilised the report section to identify previously unknown triggers. The report section provides users with a comprehensive overview of their asthma-related data, enabling them to analyse trends, identify potential triggers, and make informed decisions regarding their self-management strategies. This feature enhances users’ understanding of their asthma and helps them proactively manage their condition.
Enhanced Monitoring: 88.0% expressed interest in additional charts based on solution data for enhanced monitoring. By providing additional visual representations of their asthma data, such as charts and graphs, the solution can offer users a more comprehensive and intuitive view of their condition. Enhanced monitoring capabilities facilitate better tracking of symptoms, triggers, and medication usage, enabling users to make data-driven decisions to optimize their asthma management.

Discussion:

The findings of this study indicate that the implementation of the QIoT solution has resulted in significant improvements in various aspects of asthma management. The solution’s features have positively impacted symptom control, peak flow testing, trigger awareness, self-management behaviours, and patient education.

One notable finding is that a substantial percentage of users reported experiencing improved symptom control. Specifically, 40% of participants reported going six or more days without any asthma symptoms, while 30% reported going four or more days without symptoms. This indicates that the solution has been effective in helping patients achieve better control over their asthma symptoms.

Furthermore, the functionality to calculate daily peak flow test scores against the patient baseline number was found to be helpful by 70% of users. This feature enables users to monitor their peak flow readings and track their progress over time, providing valuable information for asthma management. By actively engaging with this feature, patients are empowered to make informed decisions regarding their asthma treatment and adjust their medication or lifestyle accordingly.

Furthermore, the findings of this study regarding extended periods without any asthma symptoms are particularly significant in terms of medication adherence and its impact on hospitalisations and deaths. Research conducted by Asthma UK in 2017 highlighted that two-thirds of all asthma deaths and emergency hospitalisations are preventable if patients were adherent to their prescribed medication. The ability of the QIoT solution to track symptom-free days and record emergency steroid medication usage provides valuable data for healthcare professionals. By accurately capturing these instances and ensuring the correct level of adherence to medication, it contributes to creating healthier patients and reducing preventable hospitalisations and deaths associated with asthma exacerbations. This further underscores the importance of digital health interventions in supporting asthma management and improving patient outcomes.

In addition, the ability to display asthma zones (green, amber, red, and red emergency) was also well-received by users. approximately 70% of participants found this feature helpful in effectively managing their asthma zones. By visually representing their current asthma status, the solution enables users to quickly assess their condition and take appropriate actions, such as adjusting medication or seeking medical assistance when necessary.

The impact on trigger awareness and self-management behaviours is another important outcome of this study. A significant majority of users (70%) reported increased awareness of asthma triggers, indicating that the solution has successfully enhanced their understanding of factors that can worsen their asthma symptoms. This newfound awareness allows patients to take proactive measures to avoid triggers and mitigate the risk of asthma exacerbations.

Moreover, the educational resources and quizzes were found to be valuable tools for patient education. A high percentage of participants (90%) agreed that the asthma control test quiz on the solution helped increase their understanding and management of their daily asthma. Similarly, 100% of participants agreed that the quiz and scoring of questions and answers were simple and effective in engaging them to think about their asthma management. This demonstrates the ability to provide educational support and empower patients to take an active role in managing their asthma.

The impact on healthcare utilisation and patient confidence is noteworthy. A significant percentage of participants (55.6%) reported visiting the doctor less during the trial period, attributing this decrease to increased confidence in their asthma management facilitated by the functionality and support. Additionally, 88.9% of participants felt more aware of when to take their inhaler, further highlighting the solution’s positive influence on medication adherence and self-management.

The features for recording and sharing daily incidents and reports were found to be valuable in clinical settings. All participants agreed that sharing the notes and reports section of the solution during asthma clinic appointments helped their healthcare professionals develop more tailored management plans. Additionally, 77.8% of participants agreed that the report section, which compiles all activity into user-friendly charts and graphs, helped them identify previously unknown triggers of their asthma. These findings emphasize the solution’s potential to facilitate communication and collaboration between patients and healthcare providers, ultimately leading to more effective asthma management.

Conclusion:

The findings of this study support the effectiveness and benefits of the QIoT solution in improving asthma management. The solutions features have demonstrated significant positive impacts on symptom control, adherence, peak flow testing, trigger awareness, self-management behaviours, and patient education.

By promoting discipline, engagement, and informed decision-making, the solution has resulted in reduced healthcare utilisation and increased patient confidence in managing asthma. Patients using the solution experienced improved symptom control, with a significant percentage reporting extended periods without any asthma symptoms. The functionality, including calculating peak flow test scores and displaying asthma zones, has been instrumental in helping users monitor their condition and make appropriate decisions regarding their asthma treatment.

Moreover, the solution has enhanced trigger awareness, self-management behaviours, and patient education. It has provided users with valuable insights into their asthma triggers, enabling them to take proactive measures to avoid exacerbations. The educational resources and quizzes on the solution have increased patients’ understanding and management of their asthma, empowering them to actively participate in their own care.

Additionally, the solution has shown promise in reducing healthcare utilisation, as evidenced by a decrease in doctor visits among participants. The solution’s features for recording incidents and generating reports have facilitated more personalised management plans and helped identify previously unknown triggers. By improving communication and collaboration between patients and healthcare providers, the solution has the potential to optimize asthma care and improve patient outcomes.

Based on these findings, integrating digital health interventions, such as the QIoT solution, into asthma care can enhance patient outcomes and empower individuals in managing their condition effectively. The solutions features offer valuable support to both patients and healthcare professionals, facilitating personalised asthma management plans and promoting a patient-centric approach to care.