Assessment of the effects of direct/video-observed therapy on pulmonary function test parameters and asthma control test: A single-center prospective randomized pilot study

Abstract

Background & Objective: Asthma control depends largely on adherence to inhaled controller therapy and correct inhaler technique, yet both remain suboptimal in routine practice. Telemedicine-based monitoring has emerged as a feasible strategy to support patient education and adherence. This pilot study aimed to evaluate the feasibility and potential effects of video-observed therapy (VOT) on pulmonary function test parameters and Asthma Control Test (ACT) scores in adults with asthma.

Methodology: This single-center, randomized prospective pilot study was conducted between January 2024 and August 2024 at Giresun Dr. Ali Menekşe Chest Diseases Hospital on asthma patients who were not in an exacerbation phase. Participants were allocated to either a video-observed therapy (VOT) group or a control group using simple randomization. Patients in the VOT group received baseline inhaler training and were followed via brief (~3-minute) video calls on days 15 and 30. All patients were reassessed in person at day 45 with spirometry and ACT.

Results: Eighty-eight patients were analyzed (VOT, n = 25; control, n = 63). At baseline, the VOT group had a lower ACT score than the control group (14.9 ± 1.9 vs 17.5 ± 3.7; p < 0.001). At day 45, the VOT group showed a significant within-group increase in FEV1 (+199 mL, +6.4%; p = 0.002), whereas the control group did not. FEF25–75 improved within both groups (p = 0.005 and p = 0.026, respectively), and ACT improved by approximately 3.5 points in each group (p < 0.001 for both). After ANCOVA adjusting for baseline ACT, the between-group effect on final ACT was borderline (p = 0.0501). In multivariable linear regression, VOT was not an independent predictor of change in FEV1 (β = 2.26, p = 0.62).

Conclusion: This pilot study suggests that brief, structured video-observed therapy is feasible in routine outpatient asthma care and may support modest improvements in spirometric and patient-reported outcomes. However, adjusted analyses did not confirm an independent treatment effect, and these findings should be regarded as hypothesis-generating. Larger, multicenter randomized trials with balanced allocation, longer follow-up, and objective adherence and inhaler-technique measures are needed before video-observed therapy can be recommended for routine asthma management.