The largest known trial to date of wearable digital devices for asthma management showed significant improvement in patient-reported asthma outcomes compared with usual care.
A digital asthma self-management (DASM) program for adults used consumer-grade smartphones and wearable sensors from Apple during a 12-month period. Among adults with uncontrolled asthma at baseline, participants who used DASM showed an improvement of 4.6 points on the Asthma Control Test (ACT) vs 1.8 points for the control group. The trial showed consistent DASM benefits across insurance types and ethnicities, although the benefit was lower among those who identified as African American.
“These results support continued development of digital asthma self-management programs,” said colead author Jordan Silberman, MD, PhD, Director of Clinical Analytics at Elevance Health. “The findings also underscore the need for culturally adaptive strategies to ensure equitable engagement and impact across all communities affected by asthma.”
The virtual, randomized, controlled, and decentralized study was conducted by Elevance Health and the University of California (UC) Irvine in collaboration with Apple, which provided smartwatches and sleep monitors at no cost. Participants used their personal iPhones to access a customized DASM app.
The trial enrolled 901 adults with asthma across 41 states. Most participants (71.1%) were female with a mean age of 36.6 years. A total of 21.7% self-identified as African American, 13.9% as Hispanic/Latino, and 65.1% as White individuals. Most participants (75.6%) had commercial health insurance, and 24.4% had Medicaid coverage. A majority (61.3%) had uncontrolled asthma at baseline by an ACT score of ≤ 19.
For the DASM group, the app tracked asthma-related metrics, received personalized alerts, supplied digital tools to support asthma self-management, and logged symptoms. The app was designed to promote health behavior change with a focus on symptom awareness, medication adherence, and avoidance of triggers using evidence-based education. The control group received the same devices and used a modified app that did not provide personalized alerts and other DASM features.
The primary outcome was a 12-month change in ACT score from baseline for individuals with uncontrolled asthma. A score change of ≥ 3 points is clinically important.
Secondary outcomes included measures of engagement, counts of asthma symptom logs, and counts of app use, as well as patient-reported medication adherence, readiness to change self-management behaviors, confidence in one’s ability to self-manage health, and impairment in health-related work productivity.
The 2.8-point increase in ACT score for the DASM vs control group (95% CI, 2.0-3.6; P < .001) varied by race. The treatment effect was one point for the African American group (95% CI, -0.7-2.7; P = .26) and 3.3 points for the non-African American participants (95% CI, 2.4-4.2; P < .001). There was no difference in DASM benefit by insurance type.
There was also no difference in symptom log use by insurance coverage type, but African American participants logged symptoms and opened the app less frequently than other groups. There was a positive association between DASM engagement and ACT score change over 12 months.
“We are proud to support research that not only improves chronic disease management but prioritizes underserved populations often left behind in digital innovation,” said coauthor Richard A. Lee, MD, Associate Clinical Professor of Pulmonary and Critical Care Medicine at UC Irvine.
Dr. Lee added that the results suggest opportunities to refine the DASM program to achieve more uniform outcomes across varied populations. Future work will also focus on providing more detailed analysis of health care utilization and how it relates to asthma symptom management.
References
1. Silberman J, Sarlati S, Harris B, et al. A digital asthma self-management program for adults: a randomized clinical trial. JAMA Netw Open. 2025;8(7):e2521438. doi:10.1001/jamanetworkopen.2025.21438
