Table 9 Asthma apps assessment framework and weight value of each item after three-round Delphi survey

 Asthma knowledge

Basic fact about asthma

Definition of asthma

Asthma is a chronic respiratory disease, together with airway hyperresponsiveness and airway inflammation

Causes of asthma

Asthma is caused by a combination of endogenous (genetic) and external (environment) causes

Respiratory symptoms of asthma

Repeated episodes of wheeze, shortness of breath, chest tightness and cough

Prognosis of asthma

Asthma cannot be cured, but can be effectively controlled through effective management

Early treatment

Early controller treatment of asthma is critical to achieving optimal outcomes

Asthma medications

Categories of asthma medications

Asthma medications include controller medications and reliever medications

Roles and usage of controller medications

Controller medications can be used to reduce airway inflammation, control symptoms, and reduce future risks, which must be used regularly

Roles and usage of reliever medications

Reliever medications can be used to relief breakthrough symptoms, which must be used as needed

Side-effects of asthma medications

Local side effects of ICS include oral thrush and dysphonia; osteoporosis, hypertension, and diabetes, etc. in high dose steroids; tachycardia and tremor in ß₂-agoinsts

Carrying reliever medications

Patients need to carry asthma reliever medications (such as Ventolin solution) with them in case of emergency

Management of asthma exacerbations

Early signs and symptoms of worsening asthma

The app describes early signs and symptoms of worsening asthma (sneezing, runny nose, dry cough, shortness of breath, and chest tightness, etc.)

Symptoms of asthma exacerbations

The app describes symptoms of asthma exacerbations (a progressive increase in symptoms of shortness of breath, cough, wheezing or chest tightness)

Management of asthma exacerbations

For example, patients were removed from the allergen environment, inhale ß₂ agonist, and went to see the doctor in time

Management after asthma exacerbations

Seek the cause of acute attack actively, check medication compliance, and adjust treatment plan

Asthma with comorbidities and triggers

Comorbidities of asthma

The app describes comorbidities of asthma, such as, rhinitis, sinusitis, and symptomatic gastroesophageal reflux disease, etc.

Management of comorbidities

The app provides details of treatment of rhinitis, sinusitis, and symptomatic gastroesophageal reflux disease, and psychological intervention, etc.

Triggers of asthma

The app describes triggers of asthma, such as, occupational factors, environmental factors, weather changes, drug and sports

 Skills training for effective self-management

Peak flow meter use and monitoring

The purpose of using peak flow meter

A peak flow meter is used for monitoring lung function changes in patients

Operational criteria for peak flow meter

Take a deep breath, seal your mouth tightly around the mouthpiece and then blow as hard and as fast as you soon. Check the number, re-set the pointer to zero, and repeat two more times

The same peak flow meter

The patient should use the same peak flow meter each time

The best time to use peak flow meter

PEF is measured in the morning, and then in the evening (after 10-12 h of the first time)

Inhaler devices use

Common inhaler devices

The app describes common inhaler devices, such as pressurized metered dose inhalers (pMDI), pMDI +spacer and dry power inhalers (DPIs)

The importance of correct inhaler technique

Correct inhaler technique can enhance the medication into lung, reduce asthma attack, and obtain the best clinical effect

Operational criteria for different inhaler devices

For example, usage of Diskus is that remove mouthpiece cover, position inhaler mouthpiece in mouth and seal lips, inward breath steady and deeply, remove inhaler, hold breath for a few seconds, and rinse mouth

 Non- pharmacological strategies

Measures to treat asthma triggers

Identifying risk factors that make asthma worse

The app describes factors that make asthma worse, such as allergens exposure, physical and chemical irritants, psychosocial factors, etc.

Avoidance of environmental smoke exposure

The app provides advice about avoidance of active smoking and passive smoking

Avoidance of occupation exposures

The app provides advice about avoidance of plant dust, animal dust, etc.

Avoidance of medications that may make asthma worse

The app provides advice about avoidance of aspirin, NSAIDs, and ß-blockers, etc.

Avoidance of allergen exposure

The app provides advice about avoidance of domestic mites, furred animals, fungi, and pollen, etc.

Avoidance of indoor and outdoor air pollution

The app provides advice about avoidance of domestic coal burning, cooking, and traffic pollution, etc.

Lifestyles

Avoidance of emotional stress

The app provides advice about relieving emotional stress and encouraging breathing exercises, etc.

Regular moderate physical activity

Patients should exercise regularly and given appropriate exercise advice

 Goals and planning

Goal setting (outcome/behavior)

Allow users to set behavior goals or provide behavior goals

The app allows users to record symptoms and PEF values daily, and assess asthma control level periodically, etc.

Allows users to set outcome goals or provide outcome goals

The app allows users to set the goals of asthma control

Action plans

Explain the purpose of an asthma action plan

An asthma action plan helps patients to identify early symptoms of asthma attacks and respond appropriately to improve asthma control

Allow making individualized asthma action plan, and updated in time

The app allows doctors to program asthma action plan directly into their phone or users type in manually

 Feedback and monitoring

Feedback

Provide result feedback information based on patients’ health data

The app can provide advice based on changing PEF, symptoms or ACT scores

Provide professional feedback information based on patients’ inhaler technique

The app allows users to upload the patients’ inhaler technique video through user-end, and then clinicians check inhaler technique in order to identify problematic steps

Provide feedback information based on patients’ changing asthma status

The app can provide feedback about severity of asthma based on symptoms or PEF, etc.

Allow storing and summarizing patients’ recent health data, and generating summary visualization automatically

The app allows storing patients’ data, such as symptoms, PEF or medicine use

Allow connecting medical devices or wearables to upload data and provide feedback information to patients

For example, after the sensor collecting the patients’ vital signs, the app can send the data to end-users and judge whether the patients’ health is in the normal range

Self-monitoring of behavior

Provide a diary to record PEF readings and predicted PEFR will be calculated automatically

The app allows users to type in manually or supports pair to the patients’ Bluetooth device automatically for data exchange

Provide a diary to record patients’ symptoms.

The app provides a diary to record details about wheezing/shortness of breath/sleep, etc.

Provide a diary to record medication.

The app provides a diary to record details about medication use, such as categories and frequency, etc.

Provide a diary to record return visit.

The app provides a diary to record details about return visit, such as frequency and results, etc.

Self-monitoring of outcomes of behavior

Provide a diary to record lung function test.

The app provides a diary to record details about lung function test, such as FEV₁, FVC, etc.

Provide a diary to record worsening asthma-related events.

The app provides a diary to record details about worsening asthma-related events, such as attack symptoms, duration of symptoms, and complications, etc.

Provide asthma assessment tools

The app provides asthma assessment tools to assess patient progress, such as Asthma Control Test (ACT)

 Shaping knowledge

Demonstration of behavior

Provide video tutorials or animations of peak flow meter use

The app provides video tutorials or animations to display instructions of peak flow meter for patients

Provide video tutorials or animations of inhaler devices use

The app provides video tutorials or animations to display instructions of inhaler device for patients

 Social support

Practical support

Allow establishing a cooperative relationship between doctors and patients, and providing patient-doctor communication platform or interactive consultation service

For example, the app offers online consulting service

Emotional support

Provide functions of interactive communication among patients

For example, the app provides functions of sharing information and comment, etc.

 Prompts

Reminder

Allow users to set reminders for asthma tests.

The app provides details of asthma tests reminder

Allow users to set medication reminder

The app provides details of medication reminder, such as medication name and dosage, etc.

Allow users to set reminders for return visit

The app can send information regularly to remind return visit

Provide reminders for checking inhalers

The app provides reminders for checking the date and medications dosage of inhalers

Warnings

Provide alert based on patients’ changing health data

The app can send warning information automatically when there is abnormal data

 Ease of use

Accessibility

The app can be easily accessed and obtained information

The app and its contents are accessible to all users (including all kinds of users with access barriers, such as visual impairment, hearing impairment, etc.)

Automation

The app can retrieve patients’ data automatically

The app can connect to health apparatuses to improve efficiency of data collection

User-friendly interface

All components/screens, menu labels/icons of apps are clear, intuitive, and able to use immediately

Interface design (including menu, background, colors, fonts, etc.) is scientific and reasonable. The operation steps are simple and can be operated according to window prompts without user guide. Navigation is logical and intuitive, and internal and external links are valid

 Usability

Usefulness of knowledge

Information released by apps is for patient’s needs and value

Information contained within apps is accurate and comprehensive, with high utilization rate

Rate of update

The app is updated regularly and timely

The app (including its contents, functions and technology) is updated regularly and timely