Smart Peak Flow for monitoring asthma

Level of innovation

All experts considered Smart Peak Flow to be novel. One expert considered it to be innovative because of its small size and its connection to the Smart Asthma app, which differed from standalone digital spirometers. Other novel features included its recording of visual analogue scales for symptoms and reliever use. One expert stated that Smart Peak Flow is innovative if it works and is complemented by a personalised asthma action plan in the app.

Potential patient impact

The experts believed potential benefits of Smart Peak Flow included the automatic recording and long-term storage of asthma data, which would allow for individual level comparison of asthma control. This could help with detecting asthma worsening. One expert noted that some people do not accurately record peak expiratory flow (PEF), and many do not keep this data to share with their healthcare professional. This could delay changes to diagnosis or treatment. Smart Peak Flow may therefore help healthcare professionals to change treatment quicker.

People may also find Smart Peak Flow convenient to use and there may be better adherence than standard care. One expert noted that despite all efforts, the uptake of self-monitoring and management in asthma remains low and is the main driver of continuing poor outcomes including preventable deaths. The experts considered that people who may particularly benefit from using the device included younger people, people with poorly controlled refractory asthma, people who have difficulty with recording or interpreting data and people with memory or dexterity problems.

Potential system impact

All experts considered that Smart Peak Flow could replace mechanical peak flow meters or standalone digital peak flow meters. One expert commented that real-time data collection and analysis would allow for more timely clinical decision making and treatment optimisation. Smart Peak Flow may also allow sharing of patient data across primary or secondary care settings. This could be used to improve the selection of people for expensive biologic therapies for asthma.

Two experts commented that monitoring asthma deterioration to facilitate treatment change could potentially reduce hospital admissions and steroid burden. This may lead to long-term cost savings. However, they noted that there is currently no evidence of this for Smart Peak Flow. One expert commented that Smart Peak Flow could be cost effective if it works and is used by more people than mechanical peak flow meters. Two experts advised that Mini‑Wright is the gold standard in peak flow meters. This device is widely used in standard care and is well validated. One expert cautioned that digital devices are not necessarily better.

Smart Peak Flow needs a smartphone for use and appropriate software in clinic. One expert advised that some people may not have access to a smartphone or may have difficulty using the technology. Two experts believed healthcare professionals and patients would need training to use Smart Peak Flow. Another expert commented that healthcare professionals may need tester kits with software to explain to patients how the device is used.

General comments

Smart Peak Flow is used in asthma clinics in at least 1 NHS trust. Two experts considered that the device could be used in most or all district general hospitals if it is shown to be safe and efficacious. Most experts did not think there would be any potential harms from using the device. But 1 expert commented that there is potential for inaccurate PEF measurements because of technical failure or environmental factors such as lighting. They added that the ability of the device to accurately measure peak flow rate has not yet been proven and validation against the current gold standard in peak flow meters is needed. Another expert noted that the evidence did not show clear parity with established peak flow meters. All experts believed that more research on Smart Peak Flow is needed, including evidence of patient-reported and asthma-related outcomes, patient engagement in self-monitoring, adherence compared with mechanical peak flow meters, patient satisfaction, adverse events including device failure, and the effect on clinical decision making and resource use.