INTRODUCTION:Adherence to controller medication is a major problem in asthma management, being difficult to assess and tackle. mHealth apps can be used to assess adherence. We aimed to assess the adherence to inhaled corticosteroids+long-acting β2-agonists (ICS+LABA) in users of the MASK-air® app, comparing the adherence to ICS+formoterol (ICS+F) with that to ICS+other LABA. MATERIALS AND METHODS:We analysed complete weeks of MASK-air® data (2015-2022; 27 countries) from patients with self-reported asthma and ICS+LABA use. We compared patients reporting ICS+F versus ICS+other LABA on adherence levels, symptoms and symptom-medication scores. We built regression models to assess whether adherence to ICS+LABA was associated with asthma control or short-acting beta-agonist (SABA) use. Sensitivity analyses were performed considering the weeks with no more than one missing day. RESULTS:In 2598 ICS+LABA users, 621 (23.9%) reported 4824 complete weeks and 866 (33.3%) reported weeks with at most one missing day. Higher adherence (use of medication ≥80% of weekly days) was observed for ICS+other LABA (75.1%) when compared to ICS+F (59.3%), despite both groups displaying similar asthma control and work productivity. The ICS+other LABA group was associated with more days of SABA use than the ICS+F group (median=71.4% versus 57.1% days). Each additional weekly day of ICS+F use was associated with a 4.1% less risk in weekly SABA use (95%CI=-6.5;-1.6%;p=0.001). For ICS+other LABA, the percentage was 8.2 (95%CI=-11.6;-5.0%;p<0.001). CONCLUSIONS:In asthma patients adherent to the MASK-air app, adherence to ICS+LABA was high. ICS+F users reported lower adherence but also a lower SABA use and a similar level of control.

Background: The self-reporting of asthma frequently leads to patient misidentification in epi-demiological studies. Strategies combining the triangulation of data sources may help to improve the identification of people with asthma. We aimed to combine information from the self-reporting of asthma, medication use and symptoms to identify asthma patterns in the users of an mHealth app. Methods: We studied MASK-air & REG; users who reported their daily asthma symptoms (assessed by a 0-100 visual analogue scale -"VAS Asthma") at least three times (either in three different months or in any period). K-means cluster analysis methods were applied to identify asthma pat-terns based on: (i) whether the user self-reported asthma; (ii) whether the user reported asthma medication use and (iii) VAS asthma. Clusters were compared by the number of medications used, VAS asthma levels and Control of Asthma and Allergic Rhinitis Test (CARAT) levels. Findings: We assessed a total of 8,075 MASK-air & REG; users. The main clustering approach resulted in the identification of seven groups. These groups were interpreted as probable: (i) severe/uncon-trolled asthma despite treatment (11.9-16.1% of MASK-air & REG; users); (ii) treated and partly-con-trolled asthma (6.3-9.7%); (iii) treated and controlled asthma (4.6-5.5%); (iv) untreated uncontrolled asthma (18.2-20.5%); (v) untreated partly-controlled asthma (10.1-10.7%); (vi) untreated controlled asthma (6.7-8.5%) and (vii) no evidence of asthma (33.0-40.2%). This classi-fication was validated in a study of 192 patients enrolled by physicians. Interpretation: We identified seven profiles based on the probability of having asthma and on its level of control. mHealth tools are hypothesis-generating and complement classical epidemio-logical approaches in identifying patients with asthma. & COPY; 2022 Sociedade Portuguesa de Pneumologia. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

The reference sites of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) were renewed in 2019. The DG Santé good practice Mobile Airways Sentinel networK was reviewed to meet the objectives of the EIP on AHA. It included 1) Management of care process, 2) Blueprint of digital transformation, 3) EIP on AHA, innovation to market, 4) Community for monitoring and assessment framework, 5) Political, organizational, technological and financial readiness, 6) Contributing to European co-operation and transferability, 7) Delivering evidence of impact against the triple win approach, 8) Contribution to the European Digital Transformation of Health and Care and 9) scale of demonstration and deployment of innovation.

Digital anamorphosis is used to define a distorted image of health and care that may be viewed correctly using digital tools and strategies. MASK digital anamorphosis represents the process used by MASK to develop the digital transformation of health and care in rhinitis. It strengthens the ARIA change management strategy in the prevention and management of airway disease. The MASK strategy is based on validated digital tools. Using the MASK digital tool and the CARAT online enhanced clinical framework, solutions for practical steps of digital enhancement of care are proposed.

The analysis of mobile health (mHealth) data has generated innovative insights into improving allergic rhinitis control, but additive information is needed. A cross-sectional real-world observational study was undertaken in 17 European countries during and outside the estimated pollen season. The aim was to collect novel information including the phenotypic characteristics of the users. The Allergy Diary–MASK-air–mobile phone app, freely available via Google Play and App, was used to collect the data of daily visual analogue scales (VASs) for overall allergic symptoms and medication use. Fluticasone Furoate (FF), Mometasone Furoate (MF), Azelastine Fluticasone Proprionate combination (MPAzeFlu) and eight oral H1-antihistamines were studied. Phenotypic characteristics were recorded at entry. The ARIA severity score was derived from entry data. This was an a priori planned analysis. 9037 users filled in 70,286 days of VAS in 2016, 2017 and 2018. The ARIA severity score was lower outside than during the pollen season. Severity was similar for all treatment groups during the pollen season, and lower in the MPAzeFlu group outside the pollen season. Days with MPAzeFlu had lower VAS levels and a higher frequency of monotherapy than the other treatments during the season. Outside the season, days with MPAzeFlu also had a higher frequency of monotherapy. The number of reported days was significantly higher with MPAzeFlu during and outside the season than with MF, FF or oral H1-antihistamines. This study shows that the overall efficacy of treatments is similar during and outside the pollen season and indicates that medications are similarly effective during the year.

An amendment to this paper has been published and can be accessed via the original article.

L’allergologue rencontre dans sa pratique de plus en plus de syndromes oraux (SO) aux fruits (Rosacées) et légumes crus, suite à l’augmentation des pollinoses (Bétulacées). Si ces SO se limitent en général à une gêne buccale, ils altèrent notablement la qualité de vie des patients atteints et posent le problème de leur prise en charge : plutôt que l’éviction, n’est-il pas possible de mettre en place une immunothérapie orale et comment ?In their daily practice, allergists are increasingly seeing oral syndrome (OS) involving fruit (Rosaceae family) and raw vegetables following an increase in pollinosis (Betulaceae family). Although oral syndromes are generally limited to oral discomfort, they in fact cause notable impairment of the quality of life of patients presenting the syndrome and pose the problem of therapy: rather than withholding the offending foodstuffs, would it not be possible to institute oral immunotherapy, and if so, how?

Summary Background Mobile technology may help to better understand the adherence to treatment. MASK ‐rhinitis (Mobile Airways Sentinel NetworK for allergic rhinitis) is a patient‐centred ICT system. A mobile phone app (the Allergy Diary) central to MASK is available in 22 countries. Objectives To assess the adherence to treatment in allergic rhinitis patients using the Allergy Diary App. Methods An observational cross‐sectional study was carried out on all users who filled in the Allergy Diary from 1 January 2016 to 1 August 2017. Secondary adherence was assessed by using the modified Medication Possession Ratio ( MPR ) and the Proportion of days covered ( PDC ) approach. Results A total of 12 143 users were registered. A total of 6 949 users reported at least one VAS data recording. Among them, 1 887 users reported ≥7 VAS data. About 1 195 subjects were included in the analysis of adherence. One hundred and thirty‐six (11.28%) users were adherent ( MPR ≥70% and PDC ≤1.25), 51 (4.23%) were partly adherent ( MPR ≥70% and PDC = 1.50) and 176 (14.60%) were switchers. On the other hand, 832 (69.05%) users were non‐adherent to medications ( MPR <70%). Of those, the largest group was non‐adherent to medications and the time interval was increased in 442 (36.68%) users. Conclusion and clinical relevance Adherence to treatment is low. The relative efficacy of continuous vs on‐demand treatment for allergic rhinitis symptoms is still a matter of debate. This study shows an approach for measuring retrospective adherence based on a mobile app. This also represents a novel approach for analysing medication‐taking behaviour in a real‐world setting.

PDS 69: Methods and statistics, Johan Friso Foyer, Floor 1, August 26, 2019, 4:30 PM - 5:30 PM Participatory mobile applications (apps) are becoming increasingly popular to monitor health conditions. Users, for example, can use these apps to report on their daily symptoms. Health apps have the potential to provide large amounts of information from large communities of individuals. These data can be used for research purposes, e.g. to understand daily patterns of symptoms and treatment use or to assess the associations between health outcomes and individual data. However, working with participatory app data offers many challenges, e.g. users can be a selected group of the general population, and among users, using or not the the app on a given day may be related with symptoms and with the exposure of interest, leading to potential biases. Here, within the context of the POLLAR (Impact of Air Pollution in Asthma and Rhinitis) project, we investigated if air pollution levels on a given day predicted the use of the MASK (Mobile Airways Sentinel networK: The Allergy Diary) app (a validated mHealth tool for allergic rhinitis management) on that same day. In particular, using data on 3,328 users from several European countries and linking their geolocation with air pollution predictions from the SILAM (System for integrated modelling of atmospheric composition) database, we found that each increase in 29 μg/m3 of daily ozone concentrations (corresponding to the interquartile range) increased the likelihood of using the app on that day by 45% (95% confidence interval: 42% to 50%). We built a Directed Acyclic Graph (DAG) that illustrates the situation of a study trying to link health app data with environmental variables, and use DAG rules for missing data to illustrate that biases are likely to attenuate real associations. Potential statistical methods to correct those biases are discussed.

Allergic Rhinitis and its Impact on Asthma (ARIA) has evolved from a guideline by using the best approach to integrated care pathways using mobile technology in patients with allergic rhinitis (AR) and asthma multimorbidity. The proposed next phase of ARIA is change management, with the aim of providing an active and healthy life to patients with rhinitis and to those with asthma multimorbidity across the lifecycle irrespective of their sex or socioeconomic status to reduce health and social inequities incurred by the disease. ARIA has followed the 8-step model of Kotter to assess and implement the effect of rhinitis on asthma multimorbidity and to propose multimorbid guidelines. A second change management strategy is proposed by ARIA Phase 4 to increase self-medication and shared decision making in rhinitis and asthma multimorbidity. An innovation of ARIA has been the development and validation of information technology evidence-based tools (Mobile Airways Sentinel Network [MASK]) that can inform patient decisions on the basis of a self-care plan proposed by the health care professional.

Seventy four Reference Sites of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) have been recognised by the European Commission in 2016 for their commitment to excellence in investing and scaling up innovative solutions for active and healthy ageing. The Reference Site Collaborative Network (RSCN) brings together the EIP on AHA Reference Sites awarded by the European Commission, and Candidate Reference Sites into a single forum. The overarching goals are to promote cooperation, share and transfer good practice and solutions in the development and scaling up of health and care strategies, policies and service delivery models, while at the same time supporting the action groups in their work. The RSCN aspires to be recognized by the EU Commission as the principal forum and authority representing all EIP on AHA Reference Sites. The RSCN will contribute to achieve the goals of the EIP on AHA by improving health and care outcomes for citizens across Europe, and the development of sustainable economic growth and the creation of jobs.

The General Data Protection Regulation (GDPR) regulates the processing of personal data in the European Union. The legal context is adapted to follow the evolution of technologies and of society. This new European regulation became mandatory, especially for connected devices, on May 25, 2018. An app originally known as "The Allergy Diary" is available for Android phones and iPhones. Its name was recently changed to MASK-air. The downloading and use of this app are free of charge and there are no adverts. It enables users to record their symptoms and their medications to better track the progress of their allergic rhinitis and/or asthma. It has been developed by public (Foundation FMC VIA-LR, University of Montpellier) and private (KYomed INNOV) organizations based in France and therefore falls under French jurisdiction. This article summarizes the five main principles of personal data protection to be respected during the development of the app: purpose, proportionality and relevance, limited retention period, security and confidentiality, as well as the rights of the people who are involved in the management of the personal data (including withdrawal and modification).

Le règlement général sur la protection des données (RGPD) encadre le traitement des données personnelles dans l’Union européenne. Le contexte juridique s’adapte pour suivre les évolutions des technologies et de nos sociétés. Ce nouveau règlement européen a été rendu obligatoire notamment pour les objets connectés le 25 mai 2018. Une application initialement connue sous le nom « Allergy Diary » est disponible pour téléphones Android et iPhones. Elle a récemment changé de nom (MASK-air). Cette application est gratuite de téléchargement et d’usage et sans publicité. Elle permet à chaque utilisateur d’enregistrer ses symptômes et ses médicaments pour effectuer un meilleur suivi de la rhinite allergique et de l’asthme. Elle est développée par des structures publiques (Fondation FMC VIA-LR, Université de Montpellier) et privées (KYomed INNOV) basées en France et relève donc de la juridiction française. Cet article fait le résumé des cinq grands principes de protection des données personnelles à respecter lors du développement de l’application : finalité, proportionnalité et pertinence, durée de conservation limitée, sécurité et confidentialité ainsi que les droits des personnes d’intervention sur la gestion de leurs données personnelles (notamment retrait et modification).

MASK-rhinite (Mobile Airways Sentinel Network pour la rhinite allergique et la multimorbidité de l’asthme) est un système de technologie de l’information et des communications (TIC) centré sur le patient. Une application gratuite pour téléphones mobiles (appelée Allergy Diary) a été développée et lancée dans 23 pays. Plusieurs résultats obtenus par MASK permettent d’avoir une approche plus proche des besoins du patient allergique. MASK permettra une meilleure approche de l’automédication, de la médecine personnalisée et de l’autonomisation des patients.

Citation for published version: Bousquet, J, Arnavielhe, S, Bedbrook, A, Alexis-Alexandre, G, Van Eerd, M, Murray, R, Canonica, GW, Illario, M, Menditto, E, Passalacqua, G, Stellato, C, Triggiani, M, Carreiro-Martins, P, Fonseca, J, MoraisAlmeida, M, Nogueira-Silva, L, Pereira, MA, Todo-Bom, A, Bosse, I, Caimmi, D, Demoly, P, Devillier, P, Fontaine, JF, Just, J, Onorato, GL, Kowalski, ML, Kuna, P, Samolinski, B, Anto, JM, Mullol, J, Valero, A, Tomazic, PV, Bergmann, KC, Keil, T, Klimek, L, Mösgues, R, Shamai, S, Zuberbier, T, Murphy, VE, McDowall, P, Price, D, Ryan, D, Sheikh, A, Chavannes, NH, Fokkens, WJ, Kvedariene, V, Valiulis, A, Bachert, C, Hellings, PW, Kull, I, Melén, E, Wickman, M, Bindslev-Jensen, C, Eller, E, Haahtela, T, Valovirta, E, Papadopoulos, NG, Annesi-Maesano, I, Bewick, M, Bosnic-Anticevich, S, Cruz, AA, de Vries, JG, Gemicioglu, B, Larenas-Linnemann, D, Laune, D, Mathieu-Dupas, E, O'Hehir, RE, Portejoie, F, Siroux, V, Spranger, O, Vandenplas, O & Yorgancioglu, A 2018, 'Treatment of allergic rhinitis using mobile technology with real world data: The MASK observational pilot study' Allergy. DOI: 10.1111/all.13406

Background Collecting data on the localization of users is a key issue for the MASK (Mobile Airways Sentinel networK: the Allergy Diary) App. Data anonymization is a method of sanitization for privacy. The European Commission’s Article 29 Working Party stated that geolocation information is personal data. To assess geolocation using the MASK method and to compare two anonymization methods in the MASK database to find an optimal privacy method. Methods Geolocation was studied for all people who used the Allergy Diary App from December 2015 to November 2017 and who reported medical outcomes. Two different anonymization methods have been evaluated: Noise addition (randomization) and k-anonymity (generalization). Results Ninety-three thousand one hundred and sixteen days of VAS were collected from 8535 users and 54,500 (58.5%) were geolocalized, corresponding to 5428 users. Noise addition was found to be less accurate than k-anonymity using MASK data to protect the users’ life privacy. Discussion k-anonymity is an acceptable method for the anonymization of MASK data and results can be used for other databases.

BACKGROUND:Multimorbidity in allergic airway diseases is well known, but no data exist about the daily dynamics of symptoms and their impact on work. To better understand this, we aimed to assess the presence and control of daily allergic multimorbidity (asthma, conjunctivitis, rhinitis) and its impact on work productivity using a mobile technology, the Allergy Diary.METHODS:We undertook a 1-year prospective observational study in which 4 210 users and 32 585 days were monitored in 19 countries. Five visual analogue scales (VAS) assessed the daily burden of the disease (i.e., global evaluation, nose, eyes, asthma and work). Visual analogue scale levels <20/100 were categorized as "Low" burden and VAS levels ≥50/100 as "High" burden.RESULTS:Visual analogue scales global measured levels assessing the global control of the allergic disease were significantly associated with allergic multimorbidity. Eight hypothesis-driven patterns were defined based on "Low" and "High" VAS levels. There were <0.2% days of Rhinitis Low and Asthma High or Conjunctivitis High patterns. There were 5.9% days with a Rhinitis High-Asthma Low pattern. There were 1.7% days with a Rhinitis High-Asthma High-Conjunctivitis Low pattern. A novel Rhinitis High-Asthma High-Conjunctivitis High pattern was identified in 2.9% days and had the greatest impact on uncontrolled VAS global measured and impaired work productivity. Work productivity was significantly correlated with VAS global measured levels.CONCLUSIONS:In a novel approach examining daily symptoms with mobile technology, we found considerable intra-individual variability of allergic multimorbidity including a previously unrecognized extreme pattern of uncontrolled multimorbidity.

BACKGROUND:Large observational implementation studies are needed to triangulate the findings from randomized control trials as they reflect "real-world" everyday practice. In a pilot study, we attempted to provide additional and complementary insights on the real-life treatment of allergic rhinitis (AR) using mobile technology.METHODS:A mobile phone app (Allergy Diary, freely available in Google Play and Apple App stores) collects the data of daily visual analog scales (VAS) for (i) overall allergic symptoms, (ii) nasal, ocular, and asthma symptoms, (iii) work, as well as (iv) medication use using a treatment scroll list including all medications (prescribed and over the counter (OTC)) for rhinitis customized for 15 countries.RESULTS:A total of 2871 users filled in 17 091 days of VAS in 2015 and 2016. Medications were reported for 9634 days. The assessment of days appeared to be more informative than the course of the treatment as, in real life, patients do not necessarily use treatment on a daily basis; rather, they appear to increase treatment use with the loss of symptom control. The Allergy Diary allowed differentiation between treatments within or between classes (intranasal corticosteroid use containing medications and oral H1-antihistamines). The control of days differed between no [best control], single, or multiple treatments (worst control).CONCLUSIONS:This study confirms the usefulness of the Allergy Diary in accessing and assessing everyday use and practice in AR. This pilot observational study uses a very simple assessment (VAS) on a mobile phone, shows novel findings, and generates new hypotheses.

A Good Practice is a practice that works well, produces good results, and is recommended as a model. MACVIA-ARIA Sentinel Network (MASK), the new Allergic Rhinitis and its Impact on Asthma (ARIA) initiative, is an example of a Good Practice focusing on the implementation of multi-sectoral care pathways using emerging technologies with real life data in rhinitis and asthma multi-morbidity. The European Union Joint Action on Chronic Diseases and Promoting Healthy Ageing across the Life Cycle (JA-CHRODIS) has developed a checklist of 28 items for the evaluation of Good Practices. SUNFRAIL (Reference Sites Network for Prevention and Care of Frailty and Chronic Conditions in community dwelling persons of EU Countries), a European Union project, assessed whether MASK is in line with the 28 items of JA-CHRODIS. A short summary was proposed for each item and 18 experts, all members of ARIA and SUNFRAIL from 12 countries, assessed the 28 items using a Survey Monkey-based questionnaire. A visual analogue scale (VAS) from 0 (strongly disagree) to 100 (strongly agree) was used. Agreement equal or over 75% was observed for 14 items (50%). MASK is following the JA-CHRODIS recommendations for the evaluation of Good Practices.

J Bousquet, MD , O VandenPlas, MD , M Bewick, MD , S Arnavielhe, PhD , A Bedbrook, BSc , R Murray, PhD , M van Eerd, MSc , J Fonseca, MD , M Morais-Almeida, MD , A Todo Bom, MD , AA Cruz, MD , F Sarquis Serpa, MD, 12 J da Silva, MD, 13 E Menditto, PhD, , G Passalacqua, MD , C Stellato , MD, 16 , MT Ventura, MD , D Caimmi, MD , P Demoly, MD , KC Bergmann, MD , T Keil, MD , L Klimek, MD , R Mösges, MD , S Shamai, MD, 22 T Zuberbier, MD , D Larenas-Linnemann, MD , M Rodriguez Gonzalez, MD, 24 MT Burguete Cabañas, MD, 25 D Ryan, MD , A Sheikh, MD , JM Anto, MD , J Mullol, MD , A Valero, MD 29 ML Kowalski, MD , P Kuna, MD , B Samolinski, MD , PV Tomazic, MD , S Bosnic-Anticevich, PhD , RE O'Hehir MD, , G De Vries, MSc , D Laune, PhD 5