The Effect of an Electronic Monitoring Device With Audiovisual Reminder Function on Adherence to Inhaled Corticosteroids and School Attendance in Children With Asthma: A Randomised Controlled Trial (Australian New Zealand Clinical Trials Registry # ACTRN12613001353785)
PURPOSE OF THE STUDY.
To investigate whether using inhalers with audiovisual reminders leads to improved asthma medication adherence and asthma outcomes among school-age children who have had emergency department visits for asthma exacerbations.
Patients aged 6 to 15 years who presented to the regional emergency department in Auckland, New Zealand, with an asthma exacerbation and who were discharged on inhaled corticosteroid controller treatment.
Patients were discharged on twice-daily inhaled fluticasone with an electronic monitoring device and assigned using a simple, unrestricted block randomization to have the audiovisual reminder function enabled (intervention) or disabled (control). The proportion of prescribed doses taken and days absent from school were measured every 2 months for 6 months. Asthma control was the secondary outcome. All analyses were conducted in the intention-to-treat population.
Patients (n = 220) were randomly assigned to the intervention (n = 110) and control (n = 110) groups. The intervention group had better adherence (median, 10th–90th percentiles: 84%, 54%–96% vs 30%, 8%–68%; P < .0001), especially for the morning dose (P = .0003), improved asthma morbidity score (P = .008) and asthma control scores at 2, 4, and 6 months (P < .0001), and fewer exacerbations at 2 months (6% vs 24%, P = .015). There were no differences in forced expiratory volume in 1 second (P = .38), asthma-related school absences (P = .096), emergency visits (P = .509), or caregiver work absences (P = .167).
In school-age children with asthma exacerbations requiring an emergency visit, use of an audiovisual reminder led to significant improvements in controller medication adherence and asthma control.
This randomized control trial of audiovisual reminders for inhaled fluticasone showed improvements in objectively measured adherence and asthma outcomes, especially during the high-risk time after emergency visits, among children as young as 6 years in a population with poor baseline adherence. The increased morning-dose adherence may have represented less medication being forgotten, rather than fewer doses missed for another reason. Additional well-powered trials are needed to evaluate longer term effects on adherence, asthma control, lung function, and school absences.
- Copyright © 2015 by the American Academy of Pediatrics