Children's Hospital Colorado

Feasibility of Using Asthma Monitoring Devices for Children with High Risk Asthma

Breathing | June 15, 2018


For families

  • Asthma in children often requires daily treatment with a controller medication.
  • It can be difficult for families to follow a doctor’s recommendation for daily asthma medication for many reasons.
  • Our breathing experts studied digital medication monitoring sensors and other technological tools to see if patients would like them.
  • Parents liked the digital monitoring tools to help keep track of their child’s medication use.

For health professionals

  • Our researchers studied digital asthma monitoring sensors as part of a digital monitoring platform to determine if they would increase asthma medication adherence.
  • Patients and their providers were notified if adherence dropped or if their asthma control status got worse.
  • Providers were included in the study and reported benefits from the use of asthma monitoring sensors.

Research background: Can a digital asthma monitor help with asthma medication adherence?

Children with asthma are typically prescribed a daily controller therapeutic regimen. Adherence to the asthma medication remains a problem, and day-to-day data is not provided through traditional methods of measuring adherence.

Researchers in the Breathing Institute at Children's Hospital Colorado sought to determine if it would be feasible to use commercially-available adherence monitoring sensors for children with severe asthma. They believed, if given the opportunity, patients and families would find the device easy to use and would continue to use it.

Research methods: Studying medication adherence in children with severe asthma

The study followed 25 children between the ages of 6 and 17 who were hospitalized at least once or visited the emergency room at least twice in the past year. Patients were followed for three months, and their providers were also asked to participate.

Digital health platform

The study included a medication adherence device, an online platform and a mobile application. The sensor was placed on the inhaler with a silicone cap. A mobile app accessed real time information about the child’s medication usage and included educational models and push notifications if the medication was not taken within 15 minutes of the designated time. Families with compatible smartphones received data on medication use. Families who did not have a compatible smartphone received a Bluetooth enabled hub for access to an online dashboard and emails. Providers were also enrolled in the system, received email notifications and could also log in to review their patient's information.

Photo showing the asthma monitoring device technology with mobile application, sensor and inhaler.

Patients and providers received two types of notifications:

  1. Decreased adherence (seven or more days of missed medications)
  2. Worsening asthma control status (increased use of rescue medications)


The study also consisted of surveys for enrolled patients and families: one halfway through the study and one three months after the study. Providers completed surveys at the time their first patient enrolled and then again at the time their last patient completed the study. 

Study results: Asthma medication adherence increased with use of digital asthma monitors

Participant breakdown:

Twenty-five patients and eight providers enrolled and completed the study. 48% were male; 60% were Hispanic; 20% were Black; 72% were on Medicaid; Mean age was 10 years old.

Type of medication prescribed to participants:

  • 24% fluticasone/salmeterol
  • 28% mometasone/formoterol
  • 48% fluticasone

Smartphone use by patients and families:

  • 96% owned a smartphone
  • 96% felt comfortable using a smartphone application

Digital health platform: patients

  • 90% said the device was very easy or extremely easy to use
  • 100% said the data from the application was very easy or somewhat easy to understand
  • 85% said the data helped them learn about their child’s asthma
  • 25% discussed the information with their provider
  • 62.5% said the platform changed some aspect of their care
  • 90% said they would recommend the device to a friend or family member
  • 95% said they would continue to use it

Digital health platform: providers

Providers most frequently responded that communication with their patient changed. They also said there were changes in frequency of follow-ups and allergy assessments. Providers felt patients were more likely to take their medication with the device in place. They also reported that awareness of asthma trends, triggers and symptoms increased. Most felt the device changed some aspect of care for their patients.


56% average adherence (declined over the study period)

Line graph showing that adherence rates declined over the study period from nearly 80% at week one to less than 40% at week 12. Average adherence over the study period was 56%.

Research discussion: Asthma adherence monitoring in children

The digital health platform was well received by patients and providers. Future analysis of adherence monitoring devices should consider the different experience using a smartphone application compared to a Bluetooth hub (or other modality). Most of the providers in the study recommended adopting some form of the technology into their clinics. While adherence started high, it decreased over the study period, which is consistent with previous studies.

Study limitations

  • Small sample size and control group
  • Devices do not monitor technique, only adherence
  • Short study period could have limited interactions with providers

The study authors conclude that it is feasible to use the technology to evaluate the effectiveness of interventions and to improve adherence to asthma medication use.

Future studies are underway or planned to:

  • Find effective interventions to improve adherence
  • Examine non-adherence phenotypes
  • Examine the role of patient-provider communication for adherence and shared decision-making
  • Determine which patients could benefit the most from adherence monitoring

Finally, study authors believe that digital health platforms will one day improve personalization of asthma medication therapy and give providers and patients the tools needed to improve the lives of children with asthma.

About the Breathing Institute

Our Breathing Institute provides comprehensive clinical care and consultation for children with common and complex breathing problems. Contact us at 720-777-6181.

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