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TOPLINE:

In adults with asthma, a digital asthma self-management (DASM) program improved symptom control compared with usual care, although its effectiveness varied by race, with weaker results observed among African American participants.

METHODOLOGY:

• Researchers conducted a randomized trial to evaluate the impact of a DASM program on symptom control among adults with asthma.
• A total of 899 participants (mean age, 36.6 years; 71.1% women; approximately 61.3% with uncontrolled asthma) were recruited via email between October 2020 and November 2021 to receive either the DASM program (n = 450) or usual care (n = 449).
• All the enrolled participants installed a custom smartphone app and utilized wearable devices during the trial. The DASM group received a full-featured self-management version with symptom tracking and alerts, whereas the usual care group received a limited version with only the asthma control test and collection of patient-reported outcomes.
• The primary outcomes included the 12-month change from baseline in asthma control test scores (scores ≤ 19 indicated uncontrolled asthma), and secondary outcomes included participants’ counts of symptom logs and patient-reported outcomes.

TAKEAWAY:

• Among participants with uncontrolled asthma, the DASM intervention improved mean asthma control test scores by 4.6 points at 12 months compared with a 1.8-point improvement with usual care (adjusted difference, 2.8 points; P < .001).
• The treatment effect varied by race, with between-group differences in asthma control test scores showing improvements of 1.0 point (P = .26) in African American participants and 3.3 points (P < .001) in non-African American participants.
• Symptom logging rates were comparable across insurance and ethnicity subgroups, with no significant differences observed. However, African American participants logged symptoms less frequently than non-African American participants.
• Patient-reported outcomes — self-reported medication adherence, readiness to change self-management behaviors, confidence in the ability to manage one’s health, and asthma-related work productivity impairment — also favored the DASM intervention over usual care (P ≤ .001 for all).

IN PRACTICE:

“Findings reveal an opportunity to adapt the DASM program for more consistent effects throughout diverse populations. Future research is needed — quantitative and qualitative — to elucidate causes of differences in outcomes,” the authors wrote.

SOURCE:

The study was led by Jordan Silberman, MD, PhD, Office of Medical Policy and Technology Assessment, Elevance Health, Palo Alto, California. It was published online on July 17, 2025, in JAMA Network Open.

LIMITATIONS:

The study was limited by the requirement for iPhone ownership, exclusion of uninsured participants, lack of blinding, and potential for biased missingness despite robust sensitivity analyses.

DISCLOSURES:

This study was funded by Elevance Health, Inc. (formerly Anthem Inc.), with support from Apple Inc. Three authors declared receiving financial support from Apple or grants from Elevance Health. One author reported receiving stock from Elevance Health. Few other authors reported receiving financial aid from the University of California and pharmaceutical companies, including Pfizer, AstraZeneca, and Eli Lilly and Company.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.