Digital, remotely delivered management interventions for adult asthma: a systematic review and meta-analysis

Background Remote, digitally delivered asthma management is increasingly used in routine care, but its long-term impact on core clinical outcomes in adults remains uncertain. Methods We conducted a systematic review and meta-analysis of randomized controlled trials evaluating interactive remote digital management (smartphone applications or web-based platforms) vs. usual care in adults with physician-diagnosed asthma and ≥6 months follow-up. Primary outcome was Mini Asthma Quality of Life Questionnaire (mini-AQLQ) at 6 and 12 months. Secondary outcomes included Asthma Control Questionnaire (ACQ) at 12 months, FEV 1 % predicted at 12 months. Random-effects models generated pooled mean differences (MD) or risk ratios. Results Ten trials were included. Remote digital interventions improved mini-AQLQ at 6 months (MD 0.47, 95% CI 0.02 to 0.92) and 12 months (MD 0.35, 95% CI: 0.21 to 0.49) and ACQ at 12 months (MD −0.37, 95% CI: −0.62 to 0.13). FEV 1 % predicted increased at 12 months (MD 4.49%, 95% CI: 1.11 to 7.87). Subgroup analyses suggested more consistent benefits for web-based programs than for app-based interventions. GRADE rated evidence as high for FEV 1 % predicted, moderate for 12-month mini-AQLQ, and very low for ACQ and 6-month mini-AQLQ due to risk of bias and inconsistency. Conclusions Interactive remote digital management statistically significant but modest improvements in quality of life and symptom control, which did not reach the established MCID of 0.5. These findings support structured, clinician-supported digital interventions as a useful, though limited, adjunct to standard pharmacologic management for adult asthma. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251133851 , identifier: CRD420251133851.