Daily digital biomarkers in the follow-up and clustering of patients with asthma

Bernardo Sousa-Pinto^{1

2}, Florence Schleich^{3

4}, Gilles Louis^{4

5}, Bilun Gemicioglu^{6

7}, Violeta Kvedarienė^{8

9}, Frederico S Regateiro^{10

11

12}, Claudia Chaves Loureiro^{11

13}, Luis Taborda-Barata^{14

15}, Rita Amaral^{1

2}, Josep M Antó^{16

17

18}, Anna Bedbrook¹⁹, Wienczyslawa Czarlewski^{19

20}, Ignacio J Ansotegui²¹, Karl-C Bergmann^{22

23}, Matteo Bonini^{24

25}, Apostolos Bossios^{26

27}, Louis-Philippe Boulet²⁸, Fulvio Braido^{29

30}, Christopher Brightling³¹, Guy Brusselle³², Luisa Brussino^{33

34}, G Walter Canonica^{35

36}, Alvaro A Cruz³⁷, Tari Haahtela³⁸, Liam G Heaney³⁹, Michael Hyland⁴⁰, Juan Carlos Ivancevich⁴¹, Ludger Klimek^{42

43}, Marek Kulus⁴⁴, Piotr Kuna⁴⁵, Maciej Kupczyk⁴⁵, Desiree E Larenas-Linnemann⁴⁶, Michael Makris⁴⁷, Manuel Marques-Cruz^{1

2}, Sara Gil-Mata^{1

2}, Mário Morais-Almeida⁴⁸, Marek Niedoszytko⁴⁹, Markus Ollert^{50

51}, Nikolaos G Papadopoulos⁵², Vincenzo Patella^{53

54

55}, Oliver Pfaar⁵⁶, Celeste Porsbjerg⁵⁷, Francesca Puggioni³⁶, Santiago Quirce¹³, Carlos Robalo Cordeiro⁵⁸, Nicolas Roche^{59

60

61}, Boleslaw Samolinski⁶², Joaquin Sastre⁶³, Nicola Scichilone⁶⁴, Sabina Skrgat^{65

66}, Sanna Toppila-Salmi^{67

68}, Omar S Usmani^{25

69}, Arunas Valiulis^{70

71}, Brigita Gradauskiene⁷², Ilgim Vardaloğlu Koyuncu⁶, Maria Teresa Ventura^{73

74}, Rafael José Vieira^{1

2}, Arzu Yorgancioglu⁷⁵, João A Fonseca^{1

2}, Torsten Zuberbier^{22

23}, Benoit Pétré⁵, Renaud Louis^{4

5}, Jean Bousquet^{19

22

23}

Affiliations

¹ MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.
² CINTESIS@RISE - Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal.
³ Department of Pulmonary Medicine, CHU Liège, Liège, Belgium.
⁴ GIGA I3 Research Group, University of Liège, Liège, Belgium.
⁵ Department of Public Health, University of Liège, Liège, Belgium.
⁶ Department of Pulmonary Diseases, Istanbul University-Cerrahpasa, Istanbul, Turkey.
⁷ Institute of Pulmonology and Tuberculosis, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey.
⁸ Institute of Clinical Medicine, Clinic of Chest Diseases and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
⁹ Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
¹⁰ Allergy and Clinical Immunology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal.
¹¹ Coimbra Institute for Clinical and Biomedical Research (ICBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
¹² Institute of Immunology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
¹³ Pneumology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
¹⁴ Department of Immunoallergology, Cova da Beira University Hospital Centre, Covilhã, Portugal.
¹⁵ UBIAir - Clinical & Experimental Lung Centre and CICS-UBI Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal.
¹⁶ ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain.
¹⁷ Universitat Pompeu Fabra (UPF), Barcelona, Spain.
¹⁸ CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
¹⁹ ARIA, Montpellier, France.
²⁰ Medical Consulting Czarlewski, Levallois, France.
²¹ Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain.
²² Institute of Allergology Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
²³ Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany.
²⁴ Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
²⁵ National Health and Lung Institute (NHLI), Imperial College London, London, UK.
²⁶ Severe Asthma Center, Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden.
²⁷ Division of Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
²⁸ Quebec Heart and Lung Institute, Laval University, Québec City, Québec, Canada.
²⁹ Respiratory and Allergy Clinic, IRCCS - Policlinico San Martino, Genoa, Italy.
³⁰ Department of Internal Medicine (DIMI), University of Genoa, Genoa, Italy.
³¹ Institute for Lung Health, Leicester NIHR BRC, University of Leicester, UK.
³² Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.
³³ Allergy and Clinical Immunology Unit, Mauriziano Hospital, Torino, Italy.
³⁴ Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
³⁵ Asthma and Allergy Unit-IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
³⁶ Fundaçao ProAR, Federal University of Bahia and GARD/WHO Planning Group, Salvador, Bahia, Brazil.
³⁷ Skin and Allergy Hospital, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland.
³⁸ Wellcome-Wolfson Institute for Experimental Medicine, Queens University, Belfast, UK.
³⁹ Plymouth University, Plymouth, UK.
⁴⁰ Servicio de Alergia e Immunologia, Clinica Santa Isabel, Buenos Aires, Argentina.
⁴¹ Department of Otolaryngology Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany.
⁴² Center for Rhinology and Allergology, Wiesbaden, Germany.
⁴³ Department of Pediatric Respiratory Diseases and Allergology, Medical University of Warsaw, Warsaw, Poland.
⁴⁴ Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland.
⁴⁵ Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico.
⁴⁶ Allergy Unit "D Kalogeromitros", 2nd Department of Dermatology and Venereology, National & Kapodistrian University of Athens, 'Attikon' University Hospital institution institution, Athens, Greece.
⁴⁷ Allergy Center, CUF Descobertas Hospital, Lisbon, Portugal.
⁴⁸ Department of Allergology, Medical University of Gdańsk, Gdansk, Poland.
⁴⁹ Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg.
⁵⁰ Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark.
⁵¹ Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece.
⁵² Division of Allergy and Clinical Immunology, Department of Medicine, "Santa Maria della Speranza" Hospital, Salerno, Italy.
⁵³ Agency of Health ASL, Salerno, Italy.
⁵⁴ Postgraduate Programme in Allergy and Clinical Immunology, University of Naples Federico II, Naples, Italy.
⁵⁵ Section of Rhinology and Allergy, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany.
⁵⁶ Department of Respiratory and Infectious Medicine, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
⁵⁷ Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.
⁵⁸ Pneumologie, AP-HP Centre Université de Paris Cité, Hôpital Cochin, Paris, France.
⁵⁹ UMR 1016, Institut Cochin, Paris, France.
⁶⁰ Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France.
⁶¹ Allergy Service, Fundacion Jimenez Diaz, Autonoma University of Madrid, CIBERES-ISCIII, Madrid, Spain.
⁶² PROMISE Department, University of Palermo, Palermo, Italy.
⁶³ Department of Pulmonary Diseases and Allergy, Ljubljana University Medical Centre, Ljubljana, Slovenia.
⁶⁴ Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
⁶⁵ Department of Otorhinolaryngology, University of Eastern Finland and the North Savo wellbeing services county, Kuopio, Finland.
⁶⁶ Department of Allergy, Skin and Allergy Hospital, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
⁶⁷ Royal Brompton Hospital, Airways Disease Section, London, UK.
⁶⁸ Clinic of Children's Diseases, Institute of Clinical Medicine, Medical Faculty of Vilnius University, Vilnius, Lithuania.
⁶⁹ Clinic of Asthma, Allergy, and Chronic Lung Diseases, Vilnius, Lithuania.
⁷⁰ Department of Immunology and Allergology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
⁷¹ University of Bari Medical School, Bari, Italy.
⁷² Institute of Sciences of Food Production, National Research Council (ISPA-CNR), Bari, Italy.
⁷³ Department of Pulmonary Diseases, Celal Bayar University, Faculty of Medicine, Manisa, Turkey.
⁷⁴ Department of Medical Sciences, University of Torino, Torino, Italy.
⁷⁵ Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw institution, Warsaw, Poland.

PMID: 40718903
DOI: 10.1080/25310429.2025.2532980

Free article

Daily digital biomarkers in the follow-up and clustering of patients with asthma

Bernardo Sousa-Pinto et al. Pulmonology. 2025.

Free article

. 2025 Dec 31;31(1):2532980.

doi: 10.1080/25310429.2025.2532980. Epub 2025 Jul 28.

Authors

Affiliations

¹ MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.
² CINTESIS@RISE - Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal.
³ Department of Pulmonary Medicine, CHU Liège, Liège, Belgium.
⁴ GIGA I3 Research Group, University of Liège, Liège, Belgium.
⁵ Department of Public Health, University of Liège, Liège, Belgium.
⁶ Department of Pulmonary Diseases, Istanbul University-Cerrahpasa, Istanbul, Turkey.
⁷ Institute of Pulmonology and Tuberculosis, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey.
⁸ Institute of Clinical Medicine, Clinic of Chest Diseases and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
⁹ Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
¹⁰ Allergy and Clinical Immunology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal.
¹¹ Coimbra Institute for Clinical and Biomedical Research (ICBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
¹² Institute of Immunology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
¹³ Pneumology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
¹⁴ Department of Immunoallergology, Cova da Beira University Hospital Centre, Covilhã, Portugal.
¹⁵ UBIAir - Clinical & Experimental Lung Centre and CICS-UBI Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal.
¹⁶ ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain.
¹⁷ Universitat Pompeu Fabra (UPF), Barcelona, Spain.
¹⁸ CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
¹⁹ ARIA, Montpellier, France.
²⁰ Medical Consulting Czarlewski, Levallois, France.
²¹ Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain.
²² Institute of Allergology Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
²³ Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany.
²⁴ Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
²⁵ National Health and Lung Institute (NHLI), Imperial College London, London, UK.
²⁶ Severe Asthma Center, Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden.
²⁷ Division of Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
²⁸ Quebec Heart and Lung Institute, Laval University, Québec City, Québec, Canada.
²⁹ Respiratory and Allergy Clinic, IRCCS - Policlinico San Martino, Genoa, Italy.
³⁰ Department of Internal Medicine (DIMI), University of Genoa, Genoa, Italy.
³¹ Institute for Lung Health, Leicester NIHR BRC, University of Leicester, UK.
³² Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.
³³ Allergy and Clinical Immunology Unit, Mauriziano Hospital, Torino, Italy.
³⁴ Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
³⁵ Asthma and Allergy Unit-IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
³⁶ Fundaçao ProAR, Federal University of Bahia and GARD/WHO Planning Group, Salvador, Bahia, Brazil.
³⁷ Skin and Allergy Hospital, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland.
³⁸ Wellcome-Wolfson Institute for Experimental Medicine, Queens University, Belfast, UK.
³⁹ Plymouth University, Plymouth, UK.
⁴⁰ Servicio de Alergia e Immunologia, Clinica Santa Isabel, Buenos Aires, Argentina.
⁴¹ Department of Otolaryngology Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany.
⁴² Center for Rhinology and Allergology, Wiesbaden, Germany.
⁴³ Department of Pediatric Respiratory Diseases and Allergology, Medical University of Warsaw, Warsaw, Poland.
⁴⁴ Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland.
⁴⁵ Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico.
⁴⁶ Allergy Unit "D Kalogeromitros", 2nd Department of Dermatology and Venereology, National & Kapodistrian University of Athens, 'Attikon' University Hospital institution institution, Athens, Greece.
⁴⁷ Allergy Center, CUF Descobertas Hospital, Lisbon, Portugal.
⁴⁸ Department of Allergology, Medical University of Gdańsk, Gdansk, Poland.
⁴⁹ Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg.
⁵⁰ Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark.
⁵¹ Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece.
⁵² Division of Allergy and Clinical Immunology, Department of Medicine, "Santa Maria della Speranza" Hospital, Salerno, Italy.
⁵³ Agency of Health ASL, Salerno, Italy.
⁵⁴ Postgraduate Programme in Allergy and Clinical Immunology, University of Naples Federico II, Naples, Italy.
⁵⁵ Section of Rhinology and Allergy, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany.
⁵⁶ Department of Respiratory and Infectious Medicine, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
⁵⁷ Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.
⁵⁸ Pneumologie, AP-HP Centre Université de Paris Cité, Hôpital Cochin, Paris, France.
⁵⁹ UMR 1016, Institut Cochin, Paris, France.
⁶⁰ Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France.
⁶¹ Allergy Service, Fundacion Jimenez Diaz, Autonoma University of Madrid, CIBERES-ISCIII, Madrid, Spain.
⁶² PROMISE Department, University of Palermo, Palermo, Italy.
⁶³ Department of Pulmonary Diseases and Allergy, Ljubljana University Medical Centre, Ljubljana, Slovenia.
⁶⁴ Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
⁶⁵ Department of Otorhinolaryngology, University of Eastern Finland and the North Savo wellbeing services county, Kuopio, Finland.
⁶⁶ Department of Allergy, Skin and Allergy Hospital, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
⁶⁷ Royal Brompton Hospital, Airways Disease Section, London, UK.
⁶⁸ Clinic of Children's Diseases, Institute of Clinical Medicine, Medical Faculty of Vilnius University, Vilnius, Lithuania.
⁶⁹ Clinic of Asthma, Allergy, and Chronic Lung Diseases, Vilnius, Lithuania.
⁷⁰ Department of Immunology and Allergology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
⁷¹ University of Bari Medical School, Bari, Italy.
⁷² Institute of Sciences of Food Production, National Research Council (ISPA-CNR), Bari, Italy.
⁷³ Department of Pulmonary Diseases, Celal Bayar University, Faculty of Medicine, Manisa, Turkey.
⁷⁴ Department of Medical Sciences, University of Torino, Torino, Italy.
⁷⁵ Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw institution, Warsaw, Poland.

PMID: 40718903
DOI: 10.1080/25310429.2025.2532980

Abstract

Background and research question: We aimed to assess whether levels of digital biomarkers can reflect monthly patterns of asthma control.

Study design and methods: We performed a longitudinal study on patients with asthma and comorbid rhinitis who filled ≥26 days of data in a month in the MASK-air® app and who reported at least 1 day of treatment with an inhaled corticosteroid with or without a long-acting β₂-agonist (ICS ± LABA). We applied k-means cluster analysis to define clusters of months according to daily asthma control and medication use. Clusters were compared using digital biomarkers (visual analogue scale [VAS] on asthma symptoms and electronic daily asthma control score [e-DASTHMA]). We compared patients who did not switch with patients who switched their ICS ± LABA.

Results: We assessed 243 patients and 1358 months. We identified three clusters of poor asthma control despite high ICS ± LABA adherence, one cluster of poor asthma control and poor ICS ± LABA adherence, one cluster of good asthma control and high ICS ± LABA adherence and one cluster of good asthma control despite poor ICS ± LABA adherence. These clusters displayed relevant differences in VAS asthma and e-DASTHMA levels. Similar clusters were found in 'non-switchers' versus 'switchers'.

Conclusion: Levels of digital biomarkers reflect asthma control patterns and might be used to monitor patients with asthma.

Keywords: Asthma; PROMs; electronic symptom-medication score; inhaled corticosteroids; mHealth.

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Daily digital biomarkers in the follow-up and clustering of patients with asthma

Affiliations

Daily digital biomarkers in the follow-up and clustering of patients with asthma

Authors

Affiliations

Abstract

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical