A telemedicine care protocol for pediatric and adolescent patients with asthma after the COVID-19 pandemic

Abstract

Pediatric and adolescent asthma is a significant health challenge with high prevalence and socioeconomic costs. Telemedicine has emerged as a promising solution for enhancing asthma management, especially in resource-limited settings and in response to the increasing demand for specialized care, particularly after the coronavirus disease 2019 (COVID-19) pandemic. However, its integration into routine clinical practice is hindered by limited evidence and the absence of standardized protocols tailored to younger populations. Telemedicine offers the potential to optimize healthcare delivery, improve access to specialized services, and support continuous patient monitoring. This initiative aims to address current gaps in standardized practices, ensuring equitable, efficient, and personalized care, particularly in underserved regions. A systematic review of literature on telemedicine and asthma was conducted using MEDLINE, EMBASE, Cochrane Library, and PsycINFO databases, up to October 2024. Studies were evaluated for effectiveness, safety, patient satisfaction, and ethical considerations. International guidelines were also reviewed, and recommendations were formulated through a modified Delphi process with a panel of seven experts, adhering to Oxford Evidence-Based Medicine grading. Telemedicine significantly enhances asthma management, improving treatment adherence, quality of life, and patient education while reducing unplanned visits. It is particularly beneficial for regions with limited access to specialized care. However, challenges persist, including insufficient data on cost-effectiveness, gaps in professional training, and technological barriers. Telemedicine is a valuable tool for managing pediatric and adolescent asthma, offering numerous benefits in accessibility and care continuity. Nevertheless, further research is needed to address existing challenges, establish best practices, and ensure its adaptability to diverse clinical settings, ultimately paving the way for more effective and equitable asthma care.

Keywords

Pediatric asthma / adolescent asthma / telemedicine / telemedicine protocol / remote healthcare / evidence-based recommendations / COVID-19

References

[1] ACTUALIZACIÓN 5.4 DE LA GUÍA GEMA [Internet]. [cited 2024 Dec 24]. Available from: http://www.gemasma.com

[2] Alvarez-Perea A, Sánchez-García S, Cano RM, Antolín-Amérigo D, Tsilochristou O, Stukus DR. Impact Of “eHealth” in Allergic Diseases and Allergic Patients. J Investig Allergol Clin Immunol. 2019; 29: 94-102.

[3] Davies B, Kenia P, Nagakumar P, Gupta A. Paediatric and adolescent asthma: A narrative review of telemedicine and emerging technologies for the post-COVID-19 era. Clin Exp Allergy. 2021; 51: 393-401.

[4] Alvarez-Perea A, Dimov V, Popescu F, Zubeldia JM. The applications of eHealth technologies in the management of asthma and allergic diseases. Clin Transl Allergy. 2021; 11: e12061.

[5] Almonacid C, Blanco-Aparicio M, Domínguez-Ortega J, Giner J, Molina J, Plaza V, et al. Teleconsultation in the follow-up of the asthma patient. Lessons after COVID-19. Arch Bronconeumol. 2021; 57: 13-4.

[6] Kim CH, Lieng MK, Rylee TL, Gee KA, Marcin JP, Melnikow JA. School-Based Telemedicine Interventions for Asthma: A Systematic Review. Acad Pediatr. 2020; 20: 893-901.

[7] Oxford Centre for Evidence-based Medicine: Levels of evidence (March 2009) [Internet]. University of Oxford; © 2025 [cited 2024 Jan 27]. Available from: https://www.cebm.ox.ac.uk/resources/levels-of-evidence/oxford-centre-for-evidence-based-medicine-levels-of-evidence-march-2009

[8] Rodríguez-Sánchez F. Proceso de elaboración y novedades del código de deontología médica español 2022. Cuad Bioet. 2023; 34: 143-53. Spanish.

[9] Issue Information-Declaration of Helsinki. J Bone Miner Res. 2019; 34: BMi-BMii.

[10] Blakey JD, Bender BG, Dima AL, Weinman J, Safioti G, Costello RW. Digital technologies and adherence in respiratory diseases: the road ahead. Eur Respir J. 2018; 52: 1801147.

[11] Nichols A, Sonnappa-Naik M, Gardner L, Richardson C, Orr N, Jamalzadeh A, et al. COVID-19 and delivery of difficult asthma services. Archives of Disease in Childhood. 2022; 107: e15.

[12] Gerzon FLGR, Jöbsis Q, Bannier MAGE, Winkens B, Dompeling E. Discrepancy between Lung Function Measurements at Home and in the Hospital in Children with Asthma and CF. J Clin Med. 2020; 9: 1617.

[13] Morton RW, Elphick HE, Rigby AS, Daw WJ, King DA, Smith LJ, et al. STAAR: a randomised controlled trial of electronic adherence monitoring with reminder alarms and feedback to improve clinical outcomes for children with asthma. Thorax. 2017; 72: 347-54.

[14] van den Wijngaart LS, Roukema J, Boehmer ALM, Brouwer ML, Hugen CAC, Niers LEM, et al. A virtual asthma clinic for children: fewer routine outpatient visits, same asthma control. Eur Respir J. 2017; 50: 1700471.

[15] Shah AC, Badawy SM. Telemedicine in Pediatrics: Systematic Review of Randomized Controlled Trials. JMIR Pediatr Parent. 2021; 4: e22696.

[16] Burke BL Jr, Hall RW, Care SOT, Dehnel PJ, Alexander JJ, Bell DM, et al. Telemedicine: Pediatric Applications. Pediatrics. 2015; 136: e293-308.

[17] Halterman JS, Fagnano M, Tajon RS, Tremblay P, Wang H, Butz A, et al. Effect of the School-Based Telemedicine Enhanced Asthma Management (SB-TEAM) Program on Asthma Morbidity: A Randomized Clinical Trial. JAMA Pediatr. 2018; 172: e174938.

[18] Perry TT, Halterman JS, Brown RH, Luo C, Randle SM, Hunter CR, et al. Results of an asthma education program delivered via telemedicine in rural schools. Ann Allergy Asthma Immunol. 2018; 120: 401-8.

[19] Ferrante G, Licari A, Marseglia GL, Grutta SL. Digital health interventions in children with asthma. Clin Exp Allergy. 2021; 51: 212-20.

[20] Guía SEPAR para la teleconsulta de pacientes respiratorios [Internet]. SEPAR; © 2020 [cited 2024 Oct 29]. Available from: https://hipertension-pulmonar.com/images/descargas/guia-teleconsulta-separ.pdf

[21] Cómo implantar la telemedicina. Guía práctica para el día a día [Internet]. [cited 2024 Aug 27] Available from: https://www.cronicidadhoy.es/arxius/imatgesbutlleti/monografico-telemedicina.pdf

[22] Guía básica de recomendaciones para la teleconsulta [Internet]. Asociacion Salud Digital; [cited 2024 Aug 28]. Available from: https://salud-digital.es/wp-content/uploads/2020/05/Guia_ASD_mayo2020.pdf

[23] Padilla-Galo A, Soto-Campos JG, Casas-Maldonado F, Álvarez-Gutierrez FJ, Morales-García C, Romero-Falcón A, et al. Documento de consenso: retos actuales en la asistencia de pacientes con asma en época de pandemia por SARS-COV-2 en las Unidades de asma de Andalucía. Rev Esp Patol Torac. 2021; 33: 114-20. Spanish.

[24] Persaud YK, Portnoy JM. Ten Rules for Implementation of a Telemedicine Program to Care for Patients with Asthma. J Allergy Clin Immunol Pract. 2021; 9: 13-21.

[25] Poowuttikul P, Seth D. New Concepts and Technological Resources in Patient Education and Asthma Self-Management. Clin Rev Allergy Immunol. 2020; 59: 19-37.

[26] Almonacid Sánchez C. Nuevas tecnologías y asma. Rev Asma. 2018; 3: 16-20. Spanish.

[27] Sánchez CA, Aparicio MB, Ortega JD, Donaire JG, Paris JM, Marcos NS, et al. Multidisciplinary Consensus for the Monitoring and Control of Asthma Through Telemedicine. The COMETA Project. Open Respir Arch. 2021; 3: 100098.

[28] Haleem A, Javaid M, Singh RP, Suman R. Telemedicine for healthcare: Capabilities, features, barriers, and applications. Sens Int. 2021; 2: 100117.

[29] Katwa U, Rivera E. Asthma Management in the Era of Smart-Medicine: Devices, Gadgets, Apps and Telemedicine. Indian J Pediatr. 2018; 85: 757-62.

[30] Perry TT, Marshall A, Berlinski A, Rettiganti M, Brown RH, Randle SM, et al. Smartphone-based vs paper-based asthma action plans for adolescents. Ann Allergy Asthma Immunol. 2017; 118: 298-303.

[31] Culmer N, Smith T, Stager C, Wright A, Burgess K, Johns S, et al. Telemedical Asthma Education and Health Care Outcomes for School-Age Children: A Systematic Review. J Allergy Clin Immunol Pract. 2020; 8: 1908-18.

[32] Radhakrishnan D, Higginson A, Thipse M, Tessier M, Radhakrishnan A. Optimizing pediatric asthma education using virtual platforms during the COVID-19 pandemic. Allergy Asthma Clin Immunol. 2022; 18: 72.

[33] van den Wijngaart LS, Kievit W, Roukema J, Boehmer ALM, Brouwer ML, Hugen CAC, et al. Online asthma management for children is cost-effective. Eur Respir J. 2017; 50: 1701413.

[34] Xu C, Jackson M, Scuffham PA, Wootton R, Simpson P, Whitty J, et al. A randomized controlled trial of an interactive voice response telephone system and specialist nurse support for childhood asthma management. J Asthma. 2010; 47: 768-73.

[35] Beerthuizen T, Voorend-van Bergen S, van den Hout WB, Vaessen-Verberne AA, Brackel HJ, Landstra AM, et al. Cost-effectiveness of FENO-based and web-based monitoring in paediatric asthma management: a randomised controlled trial. Thorax. 2016; 71: 607-13.

[36] Snoswell CL, Rahja M, Lalor AF. A Systematic Review and Meta-Analysis of Change in Health-Related Quality of Life for Interactive Telehealth Interventions for Patients With Asthma. Value Health. 2021; 24: 291-302.

[37] Jaimini U, Thirunarayan K, Kalra M, Venkataraman R, Kadariya D, Sheth A. How Is My Child's Asthma? Digital Phenotype and Actionable Insights for Pediatric Asthma. JMIR Pediatr Parent. 2018; 1: e11988.

[38] Morais-Almeida M, Aguiar R, Martin B, Ansotegui IJ, Ebisawa M, Arruda LK, et al. COVID-19, asthma, and biological therapies: What we need to know. World Allergy Organ J. 2020; 13: 100126.

[39] Jácome C, Almeida R, Pereira AM, Amaral R, Mendes S, Alves-Correia M, et al. Feasibility and Acceptability of an Asthma App to Monitor Medication Adherence: Mixed Methods Study. JMIR Mhealth Uhealth. 2021; 9: e26442.

[40] Knibb RC, Alviani C, Garriga-Baraut T, Mortz CG, Vazquez-Ortiz M, Angier E, et al. The effectiveness of interventions to improve self-management for adolescents and young adults with allergic conditions: A systematic review. Allergy. 2020; 75: 1881-98.

[41] Belisario JSM, Huckvale K, Greenfield G, Car J, Gunn LH. Smartphone and tablet self management apps for asthma. Cochrane Database Syst Rev. 2013; 2013: CD010013.

[42] Khaleva E, Knibb R, DunnGalvin A, Vazquez-Ortiz M, Comberiati P, Alviani C, et al. Perceptions of adolescents and young adults with allergy and/or asthma and their parents on EAACI guideline recommendations about transitional care: A European survey. Allergy. 2022; 77: 1094-104.

[43] Vazquez-Ortiz M, Angier E, Blumchen K, Comberiati P, Duca B, DunnGalvin A, et al. Understanding the challenges faced by adolescents and young adults with allergic conditions: A systematic review. Allergy. 2020; 75: 1850-80.

[44] Khaleva E, Vazquez-Ortiz M, Comberiati P, DunnGalvin A, Pite H, Blumchen K, et al. Current transition management of adolescents and young adults with allergy and asthma: a European survey. Clin Transl Allergy. 2020; 10: 40.

[45] Roberts G, Vazquez-Ortiz M, Knibb R, Khaleva E, Alviani C, Angier E, et al. EAACI Guidelines on the effective transition of adolescents and young adults with allergy and asthma. Allergy. 2020; 75: 2734-52.

[46] Jochmann A, Artusio L, Jamalzadeh A, Nagakumar P, Delgado-Eckert E, Saglani S, et al. Electronic monitoring of adherence to inhaled corticosteroids: an essential tool in identifying severe asthma in children. Eur Respir J. 2017; 50: 1700910.

[47] Haynes SC, Kamerman-Kretzmer R, Khan SS, Crossen S, Lieng MK, Marcin JP, et al. Telemedicine use for pediatric asthma care: a mixed methods study. J Asthma. 2022; 59: 2431-40.