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DOI: 10.1089/tmj.2009.0048 © MARY ANN LIEBERT, INC. • VOL. 15 NO. 9 • NOVEMBER 2009 TELEMEDICINE and e-HEALTH 907
Bree Holtz, M.Sc., and Pamela Whitten, Ph.D.
Communication Arts & Sciences, Michigan State University, East
Lansing, Michigan.
Abstract
Asthma is a chronic disease and a growing health problem worldwide.
The objective of this pilot study was to test the feasibility and uti-
lization of tracking asthma symptoms through an innovative mobile
phone application. The subjects for this research project consisted of
4 individuals who are currently receiving treatment for asthma from
a primary care physician in Ingham County, Michigan. Participants
took their peak flow reading each day and used the short message
service (SMS) function on their phone and sent it to a Web server.
If they did not send it by 11 AM, they received a reminder via an
automated SMS to their phone. The resulting data suggest that this
method of management is feasible. The data also demonstrate partici-
pants’ satisfaction in monitoring their asthma in this manner. Using
mobile phones for asthma management could improve compliance
with asthma action plans and reduce adverse asthma events. Future
research could further demonstrate that mobile phones are a new and
effective method for providing healthcare.
Key words: mobile phones, asthma
Introduction
ue to the increasing prevalence of asthma1 and the associ-
ated cost of the disease2 this research set out to develop a
low-cost monitoring system utilizing mobile phone short
message service (SMS, i.e., text messaging) capabilities,
which allowed subjects to use their personal mobile phone and net-
work provider (Verizon, Sprint, etc.). The research conducted was a
pilot study to demonstrate the feasibility of this technology in asthma
management. The application utilized the text-to-email conversion
capabilities of the mobile phone companies in the United States. This
permitted subjects to keep their personal phones and plans, and did
not require use of costly off-the-shelf products.
This pilot study used the following research questions to determine
subjects’ perceptions of feasibility, usefulness, and utilization of the
mobile phone asthma management application.
RQ1: What are the participants’ perceptions of utilizing their
mobile phone to record their asthma?
RQ2: How did the participants utilize the application?
Methodology
This study used a convenience sample selected by a physician,
which included 4 subjects (aged 18–32), with a diagnosis of mild to
moderate asthma (not including exercise induced), to participate in
a month-long (per each individual) innovative asthma management
program.
The subjects were asked to participate in this study by the physician
and attended an informational meeting conducted by the researcher.
Once they provided consent, subjects were given information on the
study, how to use their mobile phone to send in readings, and training
in accessing a Web site used for this study that allowed them to view
their daily asthma entries in table (Fig. 1) and graphical forms (Fig. 2).
The subjects were already trained on how to use their peak flow
meter (PFM) properly from the physician and had an individual
asthma action plan. This asthma action plan is provided by the physi-
cian and provides the patient information on their asthma and what
to do if their reading falls in the yellow or red zone. The application
developed for this study used the patients’ yellow zone reading as the
indicator the individual needs to begin to take action.
Subjects were instructed to begin to send their PFM reading the
morning following the training. If at any point a subject did not send
in a reading, the server generated a reminder text message at 11 AM
(Fig. 3). If the reading sent by the subject was in their green range,
they received a confirmation from the system to their mobile phone.
If the reading was in the yellow range, they received a confirmation
BRIEF COMMUNICATION
Managing Asthma with Mobile Phones:
A Feasibility Study
D
908 TELEMEDICINE and e-HEALTH NOVEMBER 2009
HOLTZ AND WHITTEN
message telling them to follow their asthma action plan and call the
doctor if their symptoms did not improve.
Subjects’ text messages to and from the server were collected for
data analysis. At the end of the study period, subjects participated
in a telephone interview, at which time they answered open-ended
questions and a questionnaire developed for this study.
Results
Small sample sizes are common in pilot studies in telemedicine
research.3–6 Because this research was a pilot study to determine the
feasibility of monitoring asthma via a SMS application through use
of a single physician’s practice, the sample size was low (n = 4).
Research question 1 investigated subjects’ overall perceptions of
the SMS asthma management application, specifically regarding its
usefulness, effectiveness, and satisfaction. Subjects agreed the appli-
cation was useful in monitoring their asthma (M = 4.56). Participants
also agreed this method of managing their asthma was effective (M =
4.13). Overall, participants stated they were satisfied with this method
of using their mobile phone to manage their asthma peak flow and
Fig. 1. Online table of recorded asthma readings.
Reading Date Value
Mon May 5, 2008 08:25:49 am 300
Tue May 6, 2008 09:46:01 am 325
Wed May 7, 2008 09:00:22 am 340
Thu May 8, 2008 09:25:39 am 340
Fri May 9, 2008 03:09:07 pm 310
Sat May 10, 2008 09:34:24 am 310
Sun May 11, 2008 10:01:10 am 340
Mon May 12, 2008 09:41:50 am 310
Tue May 13, 2008 09:19:07 am 325
Wed May 14, 2008 01:14:03 pm 310
Thu May 15, 2008 09:18:30 am 350
Fri May 16, 2008 09:20:40 am 340
Sat May 17, 2008 10:01:20 am 300
Sun May 18, 2008 10:04:39 am 300
Mon May 19, 2008 08:59:03 am 310
Tue May 20, 2008 09:13:10 am 320
Tue May 20, 2008 09:13:52 am 320
Wed May 21, 2008 10:00:40 am 300
Thu May 22, 2008 08:05:15 am 320
Fri May 23, 2008 09:17:33 am 320
Sat May 24, 2008 10:01:02 am 320
Sun May 25, 2008 10:45:19 am 350
Mon May 26, 2008 11:57:31 pm 320
Tue May 27, 2008 10:02:04 am 310
Fig. 2. Online chart of recorded asthma readings.
5/5/08
5/7/08
5/9/08
5/11/08
5/13/08
5/15/08
5/17/08
5/19/08
5/21/08
5/23/08
5/25/08
5/27/08
5/29/08
5/31/08
6/2/08
6/4/08
360
340
320
300
280
260
240
Fig. 3. Reminder message example.
© MARY ANN LIEBERT, INC. • VOL. 15 NO. 9 • NOVEMBER 2009 TELEMEDICINE and e-HEALTH 909
MANAGING ASTHMA WITH MOBILE PHONES
symptoms (M = 4.13). The participants also reported that the applica-
tion was easy to use (M = 4.47). During the open-ended interviews,
subjects stated they liked the reminder feature and felt more knowl-
edgeable about their disease.
Research question 2 utilized the data captured by the application’s
database. These data include the subjects’ daily readings and whether
a reminder was sent. Participants, on average, used the system for
32.5 days. Of those days, participants needed a reminder on average
of 12.9%. Participants did not respond on average 6% of the time or
approximately 2 days. Subjects reported they were aware of the Web
application, but none of the subjects utilized it. This was confirmed
by examining the log-in records.
In summary, the pilot study demonstrated the feasibility of monitor-
ing asthma with mobile phones. This research demonstrated that the
application was perceived to be a satisfactory, useful, and effective tool
in asthma management. Subjects were compliant with monitoring their
asthma using their mobile phone; however, they did not use the Web
site. The participants also felt they had a better method with which to
communicate to the physician regarding their asthma.
LIMITATIONS
Some limitations of this study include the selection of subjects.
This research used a convenience sample selected by the study’s refer-
ring physician. Another limitation also related to the sample was its
size; however, many studies of this nature tend to have a low sample
size to demonstrate feasibility. A full study using randomized control
groups with a larger sample should be conducted in the future to fur-
ther demonstrate results and health outcomes. The readings sent in by
the subjects were self-reported, which can lead to potential data entry
errors. Lastly, the subjects used the application for only a month, thus
limiting the amount of health outcome data available and ongoing
compliance information.
Conclusions
This pilot study demonstrates that this low-cost SMS mobile
phone application is feasible in allowing people to manage their
asthma utilizing their personal phone and service provider. This
research attempted to lay a foundation of future work highlight-
ing this need for effective and cost-efficient methods of managing
chronic diseases. This future work using a larger, randomized con-
trol sample could have implications for cost reductions in asthma
management, including less time away from work or school, and
fewer trips to the emergency department. Also, health outcomes
and improved quality of life for asthma patients could also be
demonstrated. This type of health delivery platform may prove
to be important as more people worldwide have access to mobile
phones.
Disclosure Statement
No competing financial interests exist.
REFERENCES
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2. Centers for Disease Control. Asthma–DASH, Healthy Youth. 2008 [cited
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Address correspondence to:
Bree Holtz, M.Sc.
409 Communication Arts & Sciences
Michigan State University
East Lansing, MI 48824-1212
E-mail: bholtz@msu.edu
Received: April 13, 2009
Accepted: May 18, 2009
