Design of a Smartphone Application to Monitor Stress, Asthma Symptoms, and Asthma Inhaler Use.


Advances in the treatment and prevention of asthma have curtailed deaths, hospitalizations, and increases in prevalence rates during the past 30 years.1 Nevertheless, the effectiveness of long-term asthma management is mediated by behavioral factors, such as adherence to medication and psychosocial stress. In a study using ecological momentary assessment (EMA) to monitor asthma inhaler use, half of all nonadherence cases occurred while partici- pants were with their peers.2 However, the study relied on sub- jective reports of adherence. Associations between stress and asthma symptoms have been observed, but these associations have relied on retrospective self-report, potentially introducing recall bias. Laboratory studies have found causal associations between stress and biological markers of immune responses related to asthma.3,4 However, these settings may not represent real-world situations. Furthermore, both laboratory and longitudinal studies to date have not captured the effect of daily variations in adherence, stress, and symptoms.

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