Alex: Design, Development and Evaluation of a Digital Health Assistant for Paediatric Asthma

Asthma management in adolescents remains challenging due to fluctuating symptoms, inconsistent adherence, and limited continuous monitoring outside clinical settings. To address these gaps, we introduce ALEX, a multimodal digital health assistant (DHA) that integrates data from smart inhalers, portable spirometers, and wearable devices to support real-time asthma self-management. Designed through a human-centred and gamified approach, ALEX aims to overcome the well-documented decline in engagement seen in traditional digital health interventions.

The platform passively and actively collects key physiological and behavioural indicators, including daily lung function, medication use, nocturnal respiratory metrics, cough frequency, sleep quality, and activity patterns. Building on evidence that fluctuation patterns in lung function carry predictive value for asthma control and exacerbation risk, ALEX integrates these multimodal signals to provide early, user-friendly indications of deteriorating asthma status. Rather than relying solely on symptom reporting, the system supports a more continuous and objective view of disease dynamics, helping adolescents better understand and manage their condition while giving clinicians access to richer longitudinal insights.

ALEX is currently being evaluated in a six-month, multi-centre observational study with adolescents aged 10–19. During the first phase, participants use the core platform, including gamified coaching, daily monitoring, and embedded asthma education. In the second phase, the DHA is augmented with a lung-function-dynamics module, enabling exploration of how temporal patterns in lung function may improve personalised guidance and clinical decision support. This sequential design allows assessment of both the standalone impact of a gamified DHA and the added value of incorporating disease-dynamics-informed insights into everyday asthma care. By combining continuous sensing, behavioural engagement strategies, and explainable analytics, ALEX aims to establish a scalable framework for predictive, data-driven asthma management, with the potential to support more timely and equitable asthma care for adolescents globally.