Digital Asthma Program Improves Symptom Control Across Most Subgroups

A digital asthma self-management (DASM) program significantly improved symptom control for adults with asthma, according to findings from a fully virtual clinical trial published in JAMA Network Open.¹

The improvements were most notable among individuals with uncontrolled asthma at baseline, underscoring the potential of mobile health technology to support chronic disease management across diverse populations.

The randomized trial was led by Elevance Health and the University of California, Irvine, in collaboration with Apple and enrolled about 900 adults across 41 US states. Participants used an Apple Watch and a mobile app to log symptoms, monitor respiratory data, and receive personalized prompts based on deviations from their baseline health metrics.² The cohort was predominantly female (71.1%) with a mean (SD) age of 36.6 (10.5) years.¹

There were no significant differences in log counts between patients with Medicaid or commercial insurance. | Image credit: sorapop – stock.adobe.com

After 12 months, participants with uncontrolled asthma who used the DASM program improved their Asthma Control Test (ACT) scores by an average of 4.6 points, compared with just 1.8 points in the usual care group. This 2.8-point difference (95% CI, 2.0-3.6; P < .001) was significant, translating to clinical improvements in shortness of breath and management of other asthma symptoms.²

“These results support continued development of digital asthma self-management programs,” Jordan Silberman, MD, PhD, co-lead study author and director of clinical analytics at Elevance Health, said in a news release. “Findings also underscore the need for culturally adaptive strategies to ensure equitable engagement and impact across all communities affected by asthma.”

Consistent Benefits Across Insurance Types, but Racial Disparities Persist

The trial included both commercially insured and Medicaid-insured participants, allowing researchers to examine whether socioeconomic status influenced program effectiveness.¹ Improvements in ACT scores were consistent across insurance groups, but results varied by race—Black and African American participants saw only a 1.0-point improvement in ACT scores with DASM, compared with 3.3 points for participants who did not identify as Black or African American (P for interaction = .02).

While the smaller sample size among African American participants may partly explain this outcome (N = 195; n = 99 in DASM group), researchers suspect lower engagement also contributed. The DASM group overall logged a median of 7.6 symptom entries per participant per month, but African American participants logged significantly fewer entries than others (P = .02).

The authors speculated a few reasons for this gap, including that parts of the DASM program may not have been well-tailored to the cultural norms and preferences of African American participants, despite being designed for a diverse patient population.

“Second, the documented trust deficit among African American individuals in clinical research may have diminished enthusiasm for DASM,” they added. “Finally, DASM did not offer opportunities to partner with familiar peers or organizations. Programs that offer such opportunities may better establish trust and cultivate engagement.”

Additionally, there were no significant differences in median symptom log counts between Medicaid and commercially insured subgroups (P = .33), nor between Hispanic or Latino and non-Hispanic subgroups (P = .56).

Beyond symptom control, the study reported modest improvements in patient-reported medication adherence, health confidence, and work productivity among DASM program participants compared with the control group. Improvements were also seen among individuals with well-controlled asthma at baseline, although the magnitude was smaller (adjusted ACT difference, 1.6 points).

Designing for Inclusive Engagement

Researchers acknowledged several limitations, including that all participants needed to own an iPhone, and uninsured individuals were excluded—factors that could reduce generalizability. The program also lacked community-based features that might enhance trust and participation among historically marginalized groups.

To improve engagement, the authors recommend program adaptations such as culturally tailored content, partnerships with trusted community institutions, and participatory design approaches. They also called for further research into health care utilization and cost outcomes, which were collected but will be reported separately.

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
2. Study finds digital asthma program significantly improves symptom control in adults. News release. Elevance Health. July 22, 2025. Accessed July 23, 2025. https://www.elevancehealth.com/newsroom/study-finds-digital-asthma-program-significantly-improves-symptom-control-in-adults