Alex: Design, Development and Evaluation of a Digital Health Assistant for Paediatric Asthma
Poor adherence to medication and insufficient monitoring are key factors that contribute to inadequate asthma control in children and adolescents. This project aims to improve asthma control in adolescents using a smartphone-based digital health assistant (DHA) designed for remote disease monitoring and patient coaching. This novel, age‐specific longitudinal tele-monitoring system will measure lung function and inflammation, environmental exposures, and medication adherence. Through digital and AI-based approaches to passively assess the patient’s health status, this technology will minimise the patient's burden during the process of disease monitoring. Finally, the project will assess the feasibility and scalability of the DHA “Alex” for paediatric asthma monitoring in the socio-economic setting characteristic of low- and middle-income countries.
Asthma control in children and adolescents can be difficult due to poor adherence to medication and insufficient disease monitoring. Digital health assistants (DHAs) in the form of mobile apps are potentially a suitable tool for tele-monitoring of disease. However, current DHA approaches and current methods in asthma tele-monitoring require regular patient participation during disease biomarker measurements. This active participation is an additional burden to the user, rendering consistent engagement challenging. The goal of this project is to develop a novel, age-specific, smartphone-based DHA for longitudinal tele-monitoring of lung function and inflammation, environmental exposures and medication adherence. Through a gamification approach, the DHA “Alex” will employ age-tailored incentives to promote long-term engagement with young patients, while passively measuring asthma biomarkers. These methods will enable remote patient coaching and provide timely healthcare provider-led interventions based on analysis of lung function fluctuations. Additionally, the researchers will use the data to train machine learning models to enable prediction of disease progression. The team plans to implement the “Meaningful Adolescent and Youth Engagement” (MAYE) concept during the development, testing, and validation of the digital health assistant.
Following development and implementation of "Alex", the project also aims to assess the efficacy of this approach in paediatric asthma via a randomised controlled trial. Moreover, the goal will be to provide a proof-of-concept for "Alex" in a socio-economic setting characteristic of low- and middle-income countries, and thereby evaluate the feasibility and scalability of this system. Furthermore, the project’s findings may help pave the way towards extending the technology to other diseases, such as cystic fibrosis, diabetes mellitus type 1 and coeliac disease. The researchers envision DHAs as a playful and effective way for an asthma patient to always carry their doctor in their pocket and improve control of their condition. In a long-term perspective, the technology underlying “Alex” has the potential to be extended to improve control of other adolescent diseases that are also challenging to manage.
Banner image above: Mother helps child use a digital device to measure lung inflammation. Image: Bosch Healthcare Solutions GmbH
A patient holds a portable lung inflammation assessment device that communicates with the digital lung health assistant “Alex” on the patient’s smartphone. Image: Center for Digital Health Interventions at ETH Zurich and Bosch Healthcare Solutions GmbH
Data on lung disease status, medication adherence and prescribed medication doses are collected with the digital lung health assistant “Alex” and used to make predictions of disease progression and generate therapeutic recommendations to assist healthcare providers. Image: Center for Digital Health Interventions at ETH Zurich
Analysis of lung function fluctuations over a period of 4 to 6 weeks is used to assess patient’s momentary disease dynamics. This information will support the therapeutic and disease management decisions of the treating doctors within one of the arms of the project's study. Image: Department of Biomedical Engineering at University of Basel
Main elements and implementation of the digital lung health assistant “Alex” within the MobileCoach platform are depicted. Image: Department of Biomedical Engineering at University of Basel
- The research is part of the BRCCH Principal Investigator Initiative.
- The consortium is led by investigators Prof Edgar Delgado-Eckert, Prof Elgar Fleisch and Dr Torsten Schmitz Cherdron.
- Additional team members include Prof Urs Frey, Dr Filipe Barata and Prof Nicole Probst-Hensch based in Switzerland, and Prof Sorin Man and Prof Ioana Mihaiela Ciuca based in Romania.