Effect of Digital Self-Monitoring on Patient Engagement and Clinical Outcomes in Severe Asthma: A Randomized Controlled Pilot Study

Background and Objectives: Severe asthma poses significant clinical and economic burdens, with adherence to monitoring and treatment remaining a challenge despite biologic therapies. This pilot study aimed to evaluate the feasibility of telemedicine-based home monitoring using the AioCare system in patients with severe asthma and to determine if weekly reminder messages improved adherence compared to standard monitoring. Materials and Methods: In this prospective, single-center randomized controlled pilot study, 30 adults with severe asthma were assigned to either a reminder group (weekly SMS or in-app messages) or a control group without reminders. All participants performed weekly home spirometry for 12 weeks using the AioCare system. Lung function parameters, Asthma Control Test (ACT) scores, adherence to monitoring, and patient satisfaction were assessed. Longitudinal data were analyzed using mixed-effects and generalized estimating equation models. Results: Adherence to home monitoring was significantly higher in the reminder group (11.47 ± 0.92 vs. 9.13 ± 3.16 sessions; p = 0.044). Overall, patient satisfaction was higher in the intervention group (p = 0.0044), with universal endorsement of the reminders and perceived educational benefit. No significant between-group differences were observed in lung function parameters. ACT scores showed a favorable trend in both groups, with a medium between-group effect size favoring the intervention (d = 0.42), although this did not reach statistical significance. Conclusions: Home monitoring with reminders is feasible, safe, and enhances adherence and satisfaction in severe asthma, although it did not significantly affect short-term changes in lung function or symptom control. Larger, longer-term studies are warranted to determine whether these engagement benefits translate into improved long-term clinical outcomes.