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BACKGROUND A written action plan (WAP) for managing asthma exacerbations is recommended. OBJECTIVE We compared the effect on unscheduled medical contacts (UMCs) of a digital action plan (DAP) accessed via a smartphone Web application (app) combined with a WAP on paper versus the same WAP alone. METHODS This randomized, unblinded, multicenter (offline recruitment in private offices and public hospitals by physicians), parallel-group trial included asthma patients who were either children (6-12 years) or adults (18-60 years) and who had experienced at least one severe exacerbation in the previous year. They were randomized to WAP or DAP+WAP in a 1:1 ratio. The DAP (fully automated) provided treatment advice according to the severity and previous pharmacotherapy of the exacerbation. The DAP was an algorithm that recorded three to nine clinical descriptors. When using the app, the participant first assessed severity of current symptoms on a 10-point scale then entered the symptom descriptors. Before the trial (DAP development) the wordings of these descriptors and their ordering were validated by 50 parents of children with asthma and 50 adults with asthma; the app was not modified during the trial. Participants were interviewed at three, six, nine, and 12 months to record exacerbations, UMCs, and WAP and DAP use, including the subjective evaluation (availability, usefulness) of the action plans, by a research nurse. RESULTS Two-hundred and eighty participants were randomized of whom 33 were excluded due to the absence of follow-up data after randomization, leaving 247 participants (93 children, 154 adults). The WAP group had 123 participants (45 children, mean age 8.3±2.0 years; and 78 adults, 36.3±12.7 years) and the DAP+WAP group 124 participants (48 children, 9.0±1.9 years; and 76 adults, 34.5±11.3 years). Overall, the annual severe exacerbation rate was 0.53 and was not different in the two groups of participants. The mean UMC number/year was 0.31±0.62 in the WAP group and 0.37±0.82 in the DAP+WAP group (mean difference, 0.06; 95% confidence interval, -0.12 to 0.24, P=.82). Use per patient with at least one moderate or severe exacerbation was higher for the WAP (33/65 versus 15/63 for the DAP, P=.002). Thus, participants were more likely to use the WAP as compared to the DAP despite non-significant difference for the subjective evaluation of both action plans. Median symptom severity of the exacerbation self-evaluated by the participants was 4/10 and was not significantly different from symptom severity assessed by the app. CONCLUSIONS The DAP was used less often than the WAP and did not decrease the number of UMCs compared to the WAP alone, which does not call into question the interest of the action plan and its associated therapeutic education. The benefits of telehealthcare in asthma care remain to be demonstrated. CLINICALTRIAL ClinicalTrials.gov Identifier: NCT02869958.