Montefiore allergy and immunology specialist Sunit Jariwala, MD, is betting on technology to help patients manage their asthma in between doctor’s visits.
In an effort to convince patients to stick with guideline-based recommendations, Dr. Jariwala and his colleagues have devised ASTHMAXcel, an interactive and personalized smartphone app that combines asthma education with games that challenge the user’s asthma knowledge and encourage healthier behaviors.
“We’ve ‘gamified’ asthma management,” says Dr. Jariwala, an associate professor of medicine at Einstein and the lead adult allergist/immunologist at the Montefiore Asthma Center.
The app, which is available for both Android and iOS phones and tablets, gives patients an ever-present virtual assistant to teach them about asthma, including when and how to use their asthma control and rescue medications and how to minimize exposure to possible triggers. A future version of the app will include personalized text messages.
“This technology empowers patients and parents to self-manage disease, and connects patients, providers, case managers, and family to improve asthma care management,” said Dr. Jariwala.
The Bronx has the highest burden of asthma in New York State and among the highest rates in the country. Environmental triggers, such as air pollution near major highways and high levels of particulate air matter, dust, cockroaches, and molds are common in the borough.
Every year, Montefiore provides patient care to over 40,000 children and adults for asthma or related illnesses. Over 6,000 children are treated in the emergency room at the Children’s Hospital at Montefiore (CHAM) for asthma or related illnesses.
In 2011, the Pulmonary and Allergy/Immunology divisions in DOM and at CHAM jointly developed Montefiore’s dedicated severe asthma center (MAC).The team-based asthma consultative diagnosis and care program, which includes an on-site allergist (Sunit Jariwala for adults), pulmonologist (Sumita Sinha, MD, for adults), and asthma educator (Ann-Marie Scalzo, for adults), has seen over 100 new patients, and has with CMO data input, been successful in reducing asthma-related hospitalizations and ER visits among uncontrolled asthmatic children and adults.
The team additionally helps patients identify asthma triggers in their homes and communities, be they environmental, psychological, or other. The Center also conducts research, some of it cutting-edge, on novel diagnostic biomarkers, and preventative and therapeutic asthma treatments.
Still, many physicians lack the tools to monitor the frequency and severity of a patient’s symptoms. And only about 50 percent of patients with persistent asthma adhere to the daily regimen of inhaled corticosteroids and other preventative or controller medications that help control symptoms and reduce morbidity. This non-compliance has prompted an NIH-funded research endeavor to improve asthma patient outreach, led by Dr. Marina Reznik with collaborators at MAC, and across the institution.
The software program was successfully piloted by 30 patients, resulting in a grant from the American Lung Association for $75,000 per year for two years to create a pediatric version. An additional small grant from the Stony Wold-Herbert Fund will go toward feasibility testing for using electronic sensors and explore the impact of real-time remote monitoring on asthma outcomes.
Dr. Jariwala said, “We hope the app will help patients avoid unnecessary hospitalizations and improve their quality of life.”
We have been working with the Chest Research Foundation (Pune, India) to adapt the existing ASTHMAXcel mobile app into a Marathi version. We translated the ASTHMAXcel app content and our evaluation questionnaires into Marathi. We will soon launch the adapted app, and will pilot test the tool among adult asthma patients evaluated at the Chest Research Foundation. We will evaluate the app's impact on asthma knowledge, clinical outcomes, and process outcomes. We will iteratively refine the app based on patient and provider feedback. The study results will serve as preliminary data for an upcoming extramural grant application.
Tuesday, July 30, 2019