EFFECTIVENESS OF PEAK EXPIRATORY FLOW RATE (PEFR) INTEGRATED MOBILE HEALTH APPLICATIONS ON ASTHMA CONTROL, EXACERBATION FREQUENCY, AND TREATMENT ADHERENCE IN PATIENTS WITH ASTHMA: A SYSTEMATIC REVIEW

Abstract

Background: Peak Expiratory Flow Rate (PEFR) monitoring is a simple, low-cost method of assessing airway obstruction in asthma, but paper-based recording is limited by poor adherence and unreliable data capture. Mobile health (mHealth) applications that integrate PEFR self-monitoring have been proposed as a means of improving asthma self-management and guiding treatment titration, but the evidence for this specific class of intervention has not been synthesised separately from broader digital-asthma-app literature. Objective To systematically review the effectiveness of mobile/electronic applications that incorporate PEFR self-monitoring on asthma control, exacerbation frequency, adherence to monitoring, lung function, quality of life, and feasibility outcomes in patients with asthma. Methods A structured literature search of PubMed/MEDLINE-indexed publications and trial registries (ClinicalTrials.gov) was conducted for studies published without a lower date restriction up to 2026, describing a mobile, smartphone, or web/electronic application with a defined PEFR self-monitoring component and a clinical, adherence, or feasibility outcome. Two broad prior systematic reviews of general asthma mHealth apps were used to cross-check completeness. Data were extracted on study design, population, intervention features, comparator, and outcomes. Risk of bias was appraised qualitatively (Cochrane RoB2 principles for randomised trials; ROBINS-I principles for non-randomised studies). Because of substantial clinical and methodological heterogeneity across interventions, comparators, outcome measures, and follow-up durations, a narrative synthesis was performed; meta-analysis was not undertaken. Results Eleven primary studies met the eligibility criteria, comprising eight randomised or cluster/school-based controlled trials, one prospective observational cohort, one longitudinal observational study, and one pre-randomised-trial usability/development study, spanning 2005 to 2025. Sample sizes ranged from small pilot/usability cohorts to 290 participants. PEFR-integrated applications were associated with directionally favourable, though generally small and imprecise, improvements in asthma control scores and quality of life across most trials. Evidence for reductions in exacerbations and healthcare utilisation was mixed. Electronic capture of PEFR appeared to improve completeness of monitoring data compared with historical paper-diary compliance benchmarks. No dedicated cost-effectiveness evaluation of a PEFR-integrated application was identified. Conclusion Mobile applications that integrate PEFR self-monitoring show a consistent, if modest, signal of benefit for asthma control, quality of life, and monitoring adherence, but the certainty of evidence is low to very low owing to small trials, heterogeneous designs, and limited data on exacerbations and cost-effectiveness. Adequately powered, standardised trials are needed before firm practice recommendations can be made.