Improving Mobile Health for Asthma in a Pandemic: Patient Use of an Integrated COVID-19 Screener

Mobile health (mHealth) tools for difficult-to-control asthma in the ambulatory setting are lacking despite the need for routine symptom monitoring. While asthma is not a risk factor for COVID-19 infection, knowledge of COVID-19 symptom burden among patients with asthma is limited. In prior work, we developed an mHealth asthma app for patient symptom reporting between clinic visits. In the context of COVID-19, we integrated a COVID-19 symptom screener into the app. Patients were also prompted to complete the screener when reporting worsening asthma control. We conducted a nested subgroup analysis of screener use among patients enrolled in an ongoing clinical trial of the app at an academic medical center. A total of 101 patients were enrolled to the app; 75 (74.3%) used the COVID-19 screener between March-August 2021, averaging 4.04 uses per patient. Among screener users, 77% were female, 24% Black, and 24% Hispanic or Latino. For patients with worsening asthma symptoms, weekly screener completion rates ranged from 57.1% to 94.4%. Rhinitis (50%) and headache (38.8%) were the most frequently reported symptoms. Unexpectedly, dyspnea (28.6%) and cough (18.4%) were less common. Myalgias (6.1%), diarrhea (6.1%), and anosmia (2.0%) were least common. 49.4% of patients reported single symptoms, and 28.6% reported ≥4 combined symptoms. We present a scalable use case for integrating COVID-19 tools into patient-reported, asthma-focused mHealth, facilitating symptom monitoring during a pandemic. Symptom data can inform acute care management and improve understanding of COVID-19 manifestations in patients with asthma supporting public health efforts and longitudinal study.