Background
Methods
Selection of apps
Planned assessment criteria
Topic | Criteria |
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Basic facts about the nature of the condition | States that asthma is a lung disease characterized by inflammation and narrowing of the airways States that the four main symptoms of asthma are cough, wheeze, shortness of breath and chest tightness States that asthma cannot be cured (although childhood symptoms may remit) but can be effectively controlled States that the cause of asthma is not known |
The nature of treatment: relievers and preventers | States that there are two classes of medication: relievers and preventers Explains possible side effects of medication (tachycardia/tremor in Β2 agonists; thrush/cataracts/dysphonia for inhaled steroids; possible additional effects for high dose steroids) States that early treatment can prevent symptoms from worsening |
Allergen and trigger avoidance | States that recognizing and avoiding personal triggers is an important part of asthma control Provides guidance consistent with the primary and Secondary prevention components of the BTS/SIGN guidelines in relation to specific triggers |
How to use treatment | States that preventer medication must be used regularly to be effective States the importance of good inhaler technique and appropriate use of a spacer device States the importance of ensuring inhalers are in date and are not empty |
Self-monitoring and assessment skills | States that learning to recognize signs of change in asthma symptoms is an important personal skill States that all patients with asthma should have a peak flow meter Explains the purpose of a peak flow meter and how to use it States the importance of regular physician review |
The role of a written, personalized action plan | States that patients with asthma should have an up to date written action plan. Explains the purpose of an action plan (to step up and step down treatment, and to seek appropriate help in response to changing symptoms and/or peak flow) |
Recognizing and responding appropriately to acute exacerbations | Describes signs/symptoms of worsening asthma (increasing wheeze; cough; night time disturbance breathlessness limiting activity; reliever inhalers not working) States the importance of changing treatment and/or seeking help promptly Lay management of acute asthma |
Personalizing the definition of good asthma control | States that it is reasonable for most people to achieve minimal symptoms and limitation of activities Asks patients to reflect on what they would consider as good asthma control Advocates discussion with personal health provider to set treatment goals in partnership |
Statement | Evidence-base | Rationale for categorization |
---|---|---|
Secondary prevention-removal of pets from the home | Uncertain | "Complete avoidance of pet allergens is impossible [...] Although removal of such animals from the home is encouraged, even after permanent removal of the animal it can be many months before allergen levels decrease and the clinical effectiveness of this and other interventions remains unproven." [7] "The reported effects of removal of pets from homes are paradoxical, with either no benefit for asthma, or a potential for continued high exposure to induce a degree of tolerance." [5] [EPR-3 suggests that animal removal could be considered but rates the evidence Grade D which reflects panel consensus only] [6] |
Secondary prevention-fungal allergen avoidance and control measures | Uncertain | "Air conditioners and dehumidifiers may be used to reduce humidity to levels less than 50% and to filter large fungal spore. However, air conditioning and sealing of windows have also been associated with increases in fungal and house dust mite allergens." [7] "Although fungal exposure has been strongly associated with hospitalisation and increased mortality in asthma, no controlled trials have addressed the efficacy of reduction of fungal exposure in relation to control of asthma." [5] "The Expert Panel recommends consideration of measures to control indoor mold [...] but the relative contribution of fungi, house-dust mites or irritants [to asthma symptoms] is not clear." [6] |
Secondary prevention-cockroach avoidance and control measures | Uncertain | "[Measures for cockroach control] are only partially effective in removing residual allergens." [7] "Cockroach allergy is not a common problem in the UK and studies of attempts to avoid this allergen elsewhere have produced conflicting results." [5] [EPR-3 recommends cockroach control if the patient is sensitive to cockroaches]. [6] |
Secondary prevention-cessation of active smoking | Beneficial | "Secondhand smoke increases the frequency and severity of symptoms in children with asthma." [7] "Direct or passive exposure to cigarette smoke adversely affects quality of life, lung function, need for rescue medications for acute episodes of asthma and long term control with inhaled steroids." [5] "[Smoke exposure] is associated with increased symptoms, decreased lung function, and a greater use of health services among those who have asthma." [6] |
Secondary prevention-avoidance of passive smoking | Beneficial | "Asthma patients who smoke and are not treated with inhaled glucocorticosteroids, have a greater decline in lung function than asthmatic patients who do not smoke." [7] "Direct or passive exposure to cigarette smoke adversely affects quality of life, lung function, need for rescue medications for acute episodes of asthma and long term control with inhaled steroids."[5] "[Smoke exposure] is associated with increased symptoms, decreased lung function, and a greater use of health services among those who have asthma." [6] |
Secondary prevention-avoidance of exposure to air pollution | Uncertain | "Avoidance of unfavourable environmental conditions is usually unnecessary for patients whose asthma is controlled." [7] "While it might seem likely that moving from a highly polluted environment might held, in the UK, asthma is more prevalent in 12-14 year olds in non-metropolitan rather than metropolitan areas." [5] "Clinicians [should] advise patients to avoid, to the extent possible, exertion or exercise outside when levels of air pollution are high." [6] |
Secondary prevention-immunotherapy for a defined allergen | Beneficial | "Appropriate immunotherapy requires the identification and use of a single well-defined clinically relevant allergen." [7] "Immunotherapy can be considered in patients with asthma where a clinically significant allergen cannot be avoided." [5] "Immunotherapy [should] be considered for patients who have persistent asthma if evidence is clear of a relationship between symptoms and exposure to an allergen." [6] |
Secondary prevention-weight reduction in obese patients | Beneficial | "Weight reduction in obese patients with asthma has been demonstrated to improve lung function, symptoms, morbidity and health status." [7] "One randomised parallel group study has shown improved asthma control following weight reduction in obese patients with asthma." [5] "Obesity has been associated with asthma persistence and severity in both children and adults. [...W]eight loss in adults resulted in improvement in pulmonary mechanics, improved FEV1, reductions in exacerbations and courses of oral corticosteroids and improved quality of life." [6] |
Secondary prevention-seasonal influenza vaccination | Uncertain | "Patients with moderate to severe asthma should be advised to receive an influenza vaccination every year [...] however routine influenza vaccination of children and adults with asthma does not appear to protect them from asthma exacerbations or improve asthma control." [7] "Immunisations should be administered independent of any considerations related to asthma." [5] "[We recommend] that clinicians consider inactivated influenza vaccination for patients who have asthma [...] however the vaccine should not be given with the expectation that it will reduce either the frequency or severity of asthma exacerbations during the influenza season." [6] |
1 | Information must be authoritative: all medical information presented by [and/or calculations performed by an app] must be attributed to an author and his/her training in the field must be mentioned. |
2 | Purpose [of the app]: A statement clearly declaring that the [app] is not meant to replace the advice of a health professional has to be provided. A brief description of the [app]'s mission, purpose and intended audience is necessary. Another brief description of the organisation behind the [app], its mission and its purpose is also necessary. |
3 | Confidentiality: The [app publisher] must describe its privacy policy regarding how you treat confidential, private or semi-private information such as email addresses and the content of emails received from or sent to [its users] |
4 | Information must be documented, referenced and dated: All medical content [including calculations and formulae] has to have a specific date of creation and a last modification date. |
5 | Justification of claims: All information about the benefits or performance of any treatment (medical and/or surgical), commercial product or service are considered as claims. All claims have to be backed up with scientific evidence (medical journals, reports or others). |
6 | [App] contact details: The [app] must be operational and the information must be accessible and clearly presented. There must be a way to contact the [app publisher], such as a working email address or contact form, for visitors who would like to have more details or support. |
7 | Funding: [The app publisher] must include a statement declaring its sources of funding. |
8 | Editorial and advertising policy: Conflicts of interest and external influences which could affect the objectivity of the editorial content must be clearly stated in the disclaimer. All [apps] displaying paying banners have to have an advertising policy. This policy must explain how the [publisher] distinguishes between editorial and advertising content and which advertisements are accepted. Any conflict of interest has to be explained. |
Issue type | Description | Example(s) |
---|---|---|
Data entry validation | Data can be entered that are out-of-range or inappropriate. New data can overwrite existing data without warning. | Negative values of peak flow can be entered and are stored. New entries can overwrite existing data without warning. |
Functionality | A function of the app (for example, saving data, performing a calculation) does not operate as expected. | App miscalculates the score of Asthma Control Test for adults; app displays an 'unfortunately you did not beat your highest score' message even if score is 100%. |
Presentation and user interface (UI) | Content having spelling and layout mistakes. User interface controls (for example, textboxes, labels, buttons) are mislabelled, inoperative or inaccessible. Navigation between different parts of the app does not occur as expected or can lead to the user getting stuck on a particular screen. | Some controls hidden when opened on a lower resolution screen; text box for recording peak flow labelled as 'Peek Flow'; some user controls not labelled in English. |
Crash | The app stopped responding in a timely way to user input or was closed unexpectedly by the smartphone or tablet operating system. | App crashed when a backup of data entered by the user was attempted. |
Other | Any other software issue, for example an online or other data service (for example, a website that the app uses for data) is unavailable or does not work as expected. | Some linked content that is displayed within the app on allergens is broken; GPS function does not work. |