Clinicians should consider extending telemedicine in routine clinical practice to manage severe asthma, as well as other chronic respiratory diseases.
Research has shown that patients with severe asthma have a higher risk of major and frequent complications, which can lead to ED visits and hospital admissions for care.
“During the COVID-19 pandemic, restrictions on in-person visits promoted broader use of telemedicine for several chronic conditions, including asthma,” says Gabriella Guarnieri, MD. Some studies suggest that applying telemedicine to the follow-up care in patients with asthma can help reduce their respiratory symptoms and improve QOL.
Telemedicine May Empower Patients, Improve Outcomes
Empowering patients to optimize asthma control is critical to improving outcomes. Telemedicine may be a reliable tool for managing asthma, regardless of severity. Some studies have found that telemedicine can help with home spirometry, digital visits, and monitoring adherence to therapy. Although e-health technologies and telemedicine have become increasingly important in healthcare, little is known about patient perceptions regarding the management of their disease with these tools.
For a study published in the Journal of Clinical Medicine, Dr. Guarnieri and colleagues explored the aptitudes and satisfaction of patients with severe asthma regarding telemedicine tools prior to activating a telemedicine management session complemented by a standard of care. The researchers also examined experiences with self-administration of injection therapy among patients with severe asthma. The telemedicine program included quarterly virtual visits and equipping patients with a spirometer, oxyhemoglobin saturation meter, and standardized questionnaires on asthma control. Patients who self-administered injections had been previously trained by a physician on proper technique.
Patients Exhibited Confidence in Self-Care Strategies
The study team developed and emailed an ad hoc questionnaire to 180 patients with severe asthma, with 167 completing the questionnaire. Most subjects (82%) stated they were confident with the idea of doing self-measurements and self-managing their disease, whereas 7% disliked it. When asked for their preliminary opinions, 77% of patients reported they would be satisfied with virtual visits and telemedicine, and they would feel adequately followed up by their physician (Figure). However, 72% expressed a preference for conventional standard visits to the clinic.
Regarding home treatment, more than 90% of patients felt that self-injection therapy was easy to administer and safe, and they did not express concern about self-administering injections. The self-administration training offered by the clinic was rated as satisfactory by nearly all participants. Only mild adverse events were reported in 22% of patients within 2 to 3 days of self-administration, but Dr. Guarnieri notes these events subsided without therapy. The most common symptoms were bruising at the injection site, mild headaches during the evening of administration, and fatigue.
In previous research, biologics have been shown to be safe treatment options for severe asthma. In this study, Dr. Guarnieri and colleagues further confirm the safety profile of these therapies. More than two-thirds of patients did not experience any adverse events after self-administration. Those patients who did experience symptoms reported them as mild.
Clinicians Should Consider Extending Telemedicine to Manage Severe Asthma
What physicians consider useful and clinically significant for patients does not always correspond to actual or perceived needs of patients, according to Dr. Guarnieri. The study results showed an agreement between what is deemed necessary and practicable by healthcare providers and what is appreciated and perceived by patients in terms of treatment and monitoring via telehealth. “Overall, patients were in favor of a telemedicine approach without fearing they will be abandoned by their healthcare provider,” says Dr. Guarnieri, who notes that training for self-administration therapy was effective, and the idea of using self-measurements for breathing and conducting virtual visits were appreciated by patients.
Collectively, the findings suggest that extending telemedicine in routine clinical practice to manage severe asthma, as well as other chronic respiratory diseases, should be considered. “High satisfaction with treatments for severe asthma would further encourage patients to adhere to their prescribed therapies,” Dr. Guarnieri says. In future research, the study team is considering readministering the questionnaire to compare the results to those from the current study. Such data may help determine if telemedicine should be a precision medicine tool in the management of patients with severe asthma.
