Asthma is an extremely common disease, especially among adolescents: Almost 10 percent of children under the age of 17 in the United States have it. It’s also very treatable with inhaled corticosteroids. But, an estimated 50 percent of children don’t take their asthma medications on a regular basis.
Ves Dimov, MD, assistant professor of pediatrics and medicine, says this problem exists with adults too, but for kids and especially teenagers, it’s more of a problem because they just have better things on their minds.
“What happens is that their symptoms improve and they feel better before the inflammation in their lungs goes away,” he said. “Most of them don’t realize they still need to use their medication, then after they feel fine for a couple of months the next asthma attack comes and hits them very hard.”
As with other chronic diseases like diabetes, doctors are searching for ways to use mobile technology to help patients adhere to medications and build healthy habits. Young asthma patients would seem to be particularly good candidates for this approach, but in a recent review of medical literature on the use of text messaging and social media to reach asthma patients, Dimov and medical/pediatric resident Andrew Nickels, MD, found little evidence that it was effective. Dimov said this might be because the field of mobile communication between physicians and patients is relatively new and researchers are still working out study designs to see what approaches work best.
“Typically these studies used text messages, but it depends on what the text message is, how it was designed and if it was something that really stimulated that person to think a little bit, just for a few seconds, and take their medication,” he said. “If you look at the big picture, how many of them really got the message and what the message said, there’s quite a few variables there.”
Dimov still believes this can be an effective means to help adolescents manage their asthma, but the text messages and social media components have to be part of a broader program starting with education about the disease. A text message reminding a teen to take his medication is going to be much more effective if he understands how much better he will feel in the long run if he takes the medication. Positive reinforcement is key.
In his allergy clinic, Dimov uses vivid diagrams depicting what inflammation of the lungs looks like, and a plush toy set of lungs used to demonstrate how the lungs constrict during an asthma attack. Visual cues like this can build understanding of the disease and boost the urgency of any text alert that comes later.
“I think it’s very helpful to show this to a person as most of us are visual creatures. It helps you understand that you really need to get the medication to where it needs to be in the lungs, and you need treatment for at least several months to make this inflammation go away,” he said.
Despite the common perception that young people eschew face-to-face communication and prefer to do just about everything via smartphones, one of the studies Dimov reviewed found that young adults, especially males ages 18-25, didn’t feel that social media was an adequate replacement for in person communication with a physician. The interest in such a program was there, but not unless they already had a good personal relationship in place. Dimov said this is another reason why physicians shouldn’t count on new technology alone to reach the 50 percent of kids who don’t take their asthma medication regularly.
“There’s a lot of interest in using technology to improve care of chronic diseases, but it should be part of a wider, multifaceted intervention. We should have real, live support behind it,” he said. “The excitement about technology is there, but we have to try different approaches to see what works best. Our patients deserve the best care.”
Nickels A, & Dimov V (2012). Innovations in Technology: Social Media and Mobile Technology in the Care of Adolescents with Asthma. Current allergy and asthma reports PMID: 22976493