InSpire to PLAY (promote lung assessment in youth): Evolving the self-management and adherence paradigms of young people with asthma

Background: Asthma is the most common chronic disease in childhood, disproportionately affecting urban, minority, and disadvantaged children. Individualized care plans supported by daily lung-function monitoring can reduce morbidity and mortality. However, despite 20 years of interventions to increase adherence, barely 50% of US youth accurately follow their care plans. We present a feasibility study of a novel approach to increasing childrens' adherence to lung-function monitoring and care plans. InSpire combines an inexpensive, portable spirometer with the motivational power and convenience of mobile-phones and videogames.

Methods: InSpire is an incentivized system that encourages youth to monitor their lung-function correctly and follow their care plans through games that incorporate spirometry maneuvers, quizzes for increasing “Asthma Locus of Control,” weather reports on asthma triggers in the child's community, care-plan-based instant-messaging, lung-function tracking, and rewards for adherence.

Results: A pilot study of InSpire assessed likability of the graphical user interface as well as children's interest in our incentivizing system. Nearly 100% of children surveyed said they would play games like those in InSpire if they involved breathing into a spirometer. Two-thirds said they would prefer InSpire over the Piko-6, whereas 1/3 would prefer having both. No children said they would prefer the Piko-6 over InSpire.

Conclusions: Previous efforts at home-monitoring of asthma in children have experienced rapid decline in adherence. An inexpensive monitoring technology combined with the computation, communication, and display ability of a mobile-phone is a promising approach to sustainable adherence to lung-function monitoring and care plans.