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TORONTO, CANADA — A novel telehealth-based approach to reducing repeat asthma visits was feasible, well-accepted, and might ultimately improve outcomes, according to data from a pilot study presented at the 2024 annual meeting of the Pediatric Academic Societies.

Telehealth is hardly a new idea in the management of asthma, but the new initiative has several unique features, including the placement of educational focus on children, said Sean Frey, MD, MPH, an associate professor of pediatrics at the University of Rochester School of Medicine and Dentistry, New York.

"Children with asthma start sharing responsibility [for treatment] in early elementary school. By middle school, kids in many families assume half or more of the responsibility," Frey said. "Yet, education tends to be mostly directed towards the caregiver."

This approach represents "a fundamental mismatch" in care, he added.

The randomized trial called TEACHH was conducted in children aged 5-13 years who were hospitalized for uncontrolled asthma. In the intervention arm, children received instruction with the TEACHH tool kit. The other children received standard care.

The tool kit included a pictorial flip chart explaining asthma and some basic goals of treatment, a visual instruction handout with illustrations of proper inhaler technique, and a pictorial action plan with traffic light colors to drive home the differences between preventive and rescue medications. The kit also included color-coded stickers to apply to each inhaler in accordance with the action plan.

The first educational session using the tool kit took place in the hospital prior to discharge. Within a month of discharge, two telehealth sessions were conducted on a smartphone app. In both sessions, the action plan and inhaler technique were reviewed and questions were addressed. 

Caregivers were hardly ignored, but the goal "above all was the active engagement of children," Frey explained. "This was not limited to education but in skill-building." 

The telehealth sessions were intended to reinforce the key messages.

"Even if the kids and caregivers are in a bit of fog during the first session in the hospital, they will hear it again, so the telehealth visits bridge the gap between hospital and home," Frey said.

The study randomized 26 children, too few to gauge the effect on outcomes, Frey said. However, symptom-free days for children and quality-of-life scores for caregivers were numerically higher in the intervention group, although visits to the emergency department were not reduced.

Larger Trial Being Developed

A larger randomized study to look at the same basic principles is now in the late stages of planning, Frey said.

Among several modifications from the initial protocol is that children will be enrolled at the time they present to the emergency department.

"We will be involving the primary care physicians, which we did not do in the pilot study," he said. "We are also planning to look at the dose of telehealth."

According to Frey, the first telehealth visit was well accepted, but the children and parents were hearing the same information for the third time on the second telehealth visit. Some suggested in the interviews that a third round "didn't add much," he said.

The pilot study reinforced Frey's previous experience suggesting children are receptive to the idea of participating in their own care at least by age 5 years. In his clinic, most children with asthma are switched to metered dose inhalers (MDIs) and spacers from nebulizers around age 2 years, because MDIs with a spacer and proper technique are noninferior to nebulizers with proper technique and do not need a plug.

"There is evidence in the literature that children with chronic illnesses, including asthma, want to be engaged in managing their disease," Frey said.

As someone who has looked at telehealth as a tool in asthma, including pediatric asthma, Yudhistira Persaud, MD, MPH, chief of pediatric allergy at the Martin Luther King Jr. Health Center, Bronx Care Health System, New York, said he supports the basic concepts of the new study.

Author of a review of the use of telehealth for asthma management, Persaud said many, if not all, children can understand the concepts of asthma control by age 5 years.

Children like to become engaged in control of their disease, he added, and several apps exist to help children manage asthma in particular.

"The sooner that kids learn about their disease and how to keep it controlled, the better," Persaud said.

This story was updated to clarify a comment from Dr Frey. 

Frey reported no potential conflicts of interest. Persaud reported financial relationships with AstraZeneca, GlaxoSmithKline, and Teva.

Ted Bosworth is a medical journalist based in New York City.