Digital Health App Helps Asthma and Depression, 2 Trials Find

Digital Health App Helps Asthma and Depression, 2 Trials Find

A new digital health app called juli proved effective in helping patients with asthma or depression, two randomized controlled trials showed.

Boston-based juli is an AI-driven app that helps patients manage their chronic conditions, including asthma, chronic obstructive pulmonary disease, generalized anxiety disorder, major depressive disorder, bipolar disorder, migraine, hypertension and chronic pain. It takes data from electronic medical records, smartphones, wearable devices, the environment and patient questionnaires. Based on that data, juli will provide suggestions to help patients tackle their symptoms, such as walk an additional 2,000 steps than the day before or exercise indoors if there’s too much air pollution that day. It can also provide medication reminders. 

“You have a journal, which is a very important function for people with chronic conditions, and then you have a gamified area where we give you recommendations through micro behavioral changes and you can collect points and trophies and things like that,” said Bettina Hein, CEO and founder of juli, in an interview. “That data goes into our models and we look at triggers and levers, we feed those back into the app and we also feed them into a dashboard for clinicians so that they know who in their population is coasting right along, who’s teetering and who really needs help.”

The app is currently free to consumers on the Apple App Store (mostly to recruit participants for trials), but the company makes revenue by selling to providers and pharmaceutical companies, Hein said. The company declined to name its current customers.

The two randomized controlled trials — one was on asthma and one was on depression — were done in collaboration with the University College London. The asthma trial randomized 411 participants, while the depression trial randomized 908 participants. Half of the participants used juli for 8 weeks, while the other half used a version of the app with limited functionality. The asthma group’s symptoms were measured using an Asthma Control Test and the depression group’s symptoms were measured using the Patient Health Questionnaire-8 (both are common scales for these conditions).

In the asthma randomized controlled trial, patients saw their symptoms improve by more than five points on average on the Asthma Control Test, from 12.6 points to 17.93 points (a higher score is better). An improvement in symptoms includes experiencing shortness of breath less often or using an inhaler less. In the depression randomized controlled trial, patients also saw their symptoms improve by more than five points on average, from 16.09 to 10.78 (a lower score is better). An improvement in symptoms for depression includes having a better appetite or sleeping better. 

“We found this difference at eight weeks between the two groups in both trials, which was a really positive finding,” said Dr. Joseph Hayes, professor of psychiatry at University College London and co-founder of juli, in an interview. “In depression, it’s very hard to find treatments that are effective. Very frequently, trials of therapeutic interventions or drug interventions have failed at this stage, so this is amazingly positive. … The asthma finding I think was dramatic and impressive as well.”

While the company started with asthma and depression, it hopes to research its effectiveness for other conditions in the future, Hayes said.

The findings come at a time when there are endless digital health apps, but not all of them are grounded in the right research. Randomized controlled trials are one of the best ways to prove a digital solution’s effectiveness, one expert previously told MedCity News.

Other companies treating chronic conditions include Omada and Livongo, but what sets juli apart is that it treats multiple conditions, which is needed as many people battle several chronic conditions at once, Hein declared.

“It doesn’t really make sense to have all of these super specialized apps unless you have a very intense and rare condition that you need to manage in a very specialized way,” she said. “A lot of these conditions can be managed together and the advantage of that is the patient feels seen more as a person rather than this patient with this one specific condition.” 

Photo credit: Zhuyufang, Getty Images

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