Patient organisation comments

The Cystic Fibrosis Trust and Asthma UK provided their comments on Smart One.

Patient benefits

Representatives from the Cystic Fibrosis Trust and Asthma UK each provided comments on Smart One, which are summarised below.

Smart One could be a useful additional tool for people with cystic fibrosis. It uses the same technique as spirometry, which many people with cystic fibrosis are familiar with after years of practice in a clinical environment.

Smart One could help reduce the number of trips needed to the nearest cystic fibrosis specialist centre, which can be a significant distance. Remote monitoring also allows patients to avoid entering an environment where they are exposed to additional bacteria

Asthma UK stated that peak flow tests are a useful monitoring tool for asthma and many people with asthma are familiar with peak flow meters. Smart One could enable easier peak flow monitoring for people with asthma, allowing them to better recognise and treat worsening asthma to avoid an attack. The device may also improve patients' experience of yearly asthma reviews by more easily providing a record of their asthma control over the year.

Asthma UK said that Smart One is a significant change in terms of linking peak flow to a smartphone and enabling data to be viewable across time. It noted that Smart One can import data from Apple Health (on iOS systems), and so may provide data to GP systems.

At an Asthma UK panel meeting, 8 UK volunteers with asthma evaluated the potential usefulness of and barriers to Smart One. The group found that the device was easily transportable and allowed for easy monitoring. Half of the group found the device and app to be clear and intuitive. They found it helpful being able to record symptoms in the app as well as having a visual trend of their lung function measurements in the form of a graph. The group felt that younger people would be more likely to use a tool connected to their smartphone, but that all patients would be able to use it.

System benefits

Smart One may reduce unnecessary appointments in busy clinics by enabling patients to take their measurements at home and email the data to their specialist team. Emailing data to a healthcare team may make clinic visits easier and allow for earlier, preventative intervention.

Asthma UK considered that there is strong evidence that self‑management support reduces hospital admissions and emergency department visits, as well as increasing the quality of life for people with asthma. Closer monitoring of peak flow data could allow more accurate management and self‑management of asthma, escalating treatment sooner if lung function worsens and avoiding treatment if lung function is stable.

Barriers to use

The Cystic Fibrosis Trust noted that the device excludes anyone without a smartphone, which may prevent equity of access. It also noted that it is important for cystic fibrosis teams to assist users in correctly interpreting results to reduce unnecessary anxiety, which may limit the usefulness of Smart One. Additional guidance would be needed for patients to learn how to use the app and who to contact in case issues arise.

Overusing the device could have adverse effects on the lungs, potentially causing soreness, coughing or haemoptysis. For this reason, using the device twice daily in people with cystic fibrosis would have negative effects without clinical benefit. The Trust also pointed out that Smart One should not be used by more than 1 person with cystic fibrosis because of the risk of cross infection.

Asthma UK noted that some of the functions of the Smart One app may not be tailored to people with severe asthma, in whom symptoms do not get better, even when usual medicines are taken regularly and correctly. People with severe asthma may have red readings on the traffic light indicator in the app, despite their readings being potentially normal for a person with severe asthma.

Considerations for adoption

Smart One should not be used as a replacement for hospital visits and overdependence may be a problem. Cystic fibrosis teams base their decisions on more than 1 set of results and patients must be seen and assessed by their multi-disciplinary team on a regular basis.

Similar to people with cystic fibrosis, people with asthma may become overly dependent on the peak flow reading despite having worsening symptoms. It should be made clear to users that the device is a tool to help self‑management, rather than replace symptom‑based self‑assessments.

Healthcare providers should offer initial peak flow training to ensure that Smart One is being used correctly.