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Medically reviewed by Dr. Samuel Sarmiento, M.D., MPH on August 3, 2023

Compared to a written action plan alone, a digital action plan was used less frequently and did not affect the number of unscheduled medical contacts in this study.

One strategy for managing asthma symptoms is a patient-tailored asthma action plan, including self-management instructions. Giving patients a written action plan (WAP) for their asthma has the dual goals of promoting self-management and minimizing unscheduled medical contacts (UMCs). Using digital action plans (DAPs) retrieved via a smartphone may promote successful self-management.

This study, published in the Journal of Medical Internet Research, evaluated the effectiveness of a paper-based WAP and a smartphone-based DAP for reducing UMCs.

Study Design and Population

This randomized, multicenter trial included 247 asthmatics: 93 children and 154 adults, with at least one severe exacerbation in the previous year. Data were collected on exacerbations, UMCs, WAP and DAP usage, and participants’ subjective assessments of the action plans’ availability and efficacy through follow-up interviews at 3, 6, 9, and 12 months.

Frequency of Unscheduled Medical Contacts and Flare-Ups

It was found that 65 of the 123 WAP participants and 63 of the 124 DAP participants had at least one moderate or severe exacerbation, averaging 0.53 annually. The WAP group had a 0.31 annual UMC incidence, whereas the DAP+WAP group had an incidence of 0.37. The number of UMCs in the two groups was not significantly different, whether all exacerbations were considered or only moderate and severe ones.

The Written Action Plan Was Used More Often Than the Digital Plan

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WAP patients (51%) with at least one major or severe exacerbation were more likely to adopt an action plan. Thus, the mean percentage of WAP-used exacerbations was similar across the WAP and DAP+WAP groups, independent of age. In the DAP+WAP group, the mean DAP use per exacerbation was 19.8% . Despite no statistically significant difference in subjective ratings between the two action plans, participants favored the WAP.

The Digital Action Plan Could Not Classify Exacerbation Severity in Some Instances

Before entering the symptoms into the app, participants were asked to rate the severity of their symptoms on a scale from 1 to 10. The median score was 4. Due to incoherent symptoms, the DAP could not classify the degree of the exacerbation in 13% of connections to the app. Participants didn’t use the DAP mainly when their symptoms were so mild that no assistance was necessary.

Therefore, the use of DAP as part of a telemedicine approach for asthma management is still up for debate.


Beydon, N., Taillé, C., Corvol, H., Valcke, J., Portal, J., Plantier, L., Mangiapan, G., Perisson, C., Aubertin, G., Hadchouel, A., Briend, G., Guilleminault, L., Neukirch, C., Cros, P., De Vecchi, C. A., Mahut, B., Vicaut, E., & Delclaux, C. (2023b). Digital Action Plan (Web App) for Managing Asthma Exacerbations: a Randomized Trial (Preprint). Journal of Medical Internet Research, 25, e41490. https://doi.org/10.2196/41490