This retrospective analysis of real-world data examines how asthma medication usage and retention rates may differ between a digital self-management platform adopted on its own (DP) and when integrated as part of a virtual clinical care workflow (DP + TRC). At six months, patients with uncontrolled asthma in the DP + TRC group had better average controller inhaler adherence, and better program retention compared to patients in the DP group. While we observed no statistically significant differences in average SABA usage between groups at six months, both groups had similar significant improvements in SABA usage between baseline and six-month follow-up. Over time, controller adherence declined for both groups, but larger relative declines were seen in the DP vs. DP + TRC group. Overall, these results suggest that integrating digital self-management tools within a virtual clinical care workflow may enhance retention and controller adherence, while promoting similar positive changes in SABA usage, compared to using a digital self-management platform alone.

These results align well with a growing body of literature supporting the use of digital health for chronic disease management and improved clinical outcomes, including lower SABA usage and improved controller adherence3,4,5,6,12. Beyond the positive clinical benefits of digital health approaches, studies have also demonstrated that digital health can improve quality of life by reducing symptom-related disruptions at work and at school, possibly lowering rates of presenteeism and absenteeism in asthma13,14. Additionally, when thoughtfully designed and adopted, digital health approaches have the potential to bridge inequities with hard-to-reach communities and older populations, creating opportunities for easier and more regular access to healthcare providers5,13,15.

Despite success at the patient level, dissemination and scaling of digital tools and platforms into real-world clinical practice varies widely. Hybrid program design which combines digital management tools with the standard of care, is often influenced by factors such as the target population, financial constraints, staffing resources, clinical workflows, and general healthcare system readiness for the adoption of digital health tools. In a recent review on the state of digital interventions in respiratory care, the authors further refine these considerations by setting type - highlighting the differing needs in an acute setting versus remote care versus an in-office visit, for example16. As such, careful program implementation design coupled with considerations for the population served can minimize digital implementation challenges, while virtual solutions have the potential to scale digital platforms and maintain favorable clinical outcomes.

In our assessment of the DP + TRC group, both the patient and virtual clinical team had access to the patient’s medication use data, as well as tracked symptoms and triggers. This shared knowledge likely supported more nuanced clinical discussions and timely interventions. Shared decision-making can be a central part of successful chronic disease management, allowing patients to take on a more active role in their care and working with their healthcare provider to account for all aspects of chronic condition management17,18. Such approaches have been an effective tool in asthma management to date, with studies demonstrating improved adherence, clinical outcomes, and patient satisfaction, both in person and virtually.

The findings of this analysis should be interpreted in the context of its limitations. First, this study was an observational study of real-world data. As such, bias may have been introduced due to the volunteer nature of the programs and the propensity of enrolled patients for digital modalities. Further, we had limited demographic and clinical data to describe the populations. As such, the generalizability of the results may be limited. Second, while we hypothesized that both groups likely experienced similar natural fluctuations in medication usage over time, it is possible that the changes observed in both cohorts may partly reflect a regression to the mean. More robust study designs with a randomized control group may help confirm the findings observed. Third, the study compares outcomes from two different real-world programs, which had significantly different baseline characteristics. For example, the digital-only program had almost double the proportion of patients with uncontrolled asthma compared to the virtual care program, and were also significantly younger. While our analyses controlled for these differences, again robust study designs with a control arm may be warranted. Future real-world studies should consider not only the inclusion of a comparison or matched group, but also consider capturing broader sociodemographic (e.g., race, gender, socioeconomic status), quality of life, and clinical (e.g., exacerbations, acute care visits) measures to help assess generalizability. Data and assessment of the frequency, type and quality of virtual care interactions may also support an improved understanding of the mechanisms of change as well as the scaling of such programs.

While digital platforms have demonstrated promise in asthma management, questions remain on how best to expand these platforms into real-world clinical practice. A digital self-management platform for asthma management, combined with virtual clinical oversight, may offer an opportunity to further enhance patient outcomes while efficiently scaling digital health and reducing barriers to care. Future research is needed to confirm the results observed in this large real-world study, as well as to better understand the long term and economic benefits of such a scaled approach in asthma management.