e-Monitoring of Asthma Therapy to Improve Compliance in children (e-MATIC): a randomised controlled trial

Abstract

Real-time medication monitoring (RTMM) is a promising tool for improving adherence to inhaled corticosteroids (ICS), but has not been sufficiently tested in children with asthma. We aimed to study the effects of RTMM with short message service (SMS) reminders on adherence to ICS, asthma control, asthma-specific quality of life and asthma exacerbation rate; and to study the associated cost-effectiveness.In a multicentre, randomised controlled trial, children (aged 4-11 years) using ICS were recruited from five outpatient clinics and were given an RTMM device for 12 months. The intervention group also received tailored SMS reminders, sent only when a dose was at risk of omission. Outcome measures were adherence to ICS (RTMM data), asthma control (childhood asthma control test questionnaire), quality of life (paediatric asthma quality of life questionnaire) and asthma exacerbations. Costs were calculated from a healthcare and societal perspective.We included 209 children. Mean adherence was higher in the intervention group: 69.3% versus 57.3% (difference 12.0%, 95% CI 6.7%-17.7%). No differences were found for asthma control, quality of life or asthma exacerbations. Costs were higher in the intervention group, but this difference was not statistically significant.RTMM with tailored SMS reminders improved adherence to ICS, but not asthma control, quality of life or exacerbations in children using ICS for asthma.

Monitoring asthma: no matter how?

“…Nevertheless, the results of VASBINDER et al [12] are consistent with earlier published studies focusing on reminder systems to improve adherence to asthma medication [10]. None of these studies were able to document a change in clinical asthma outcomes or asthma-related quality of life.…”

“…The e-MATIC (e-Monitoring of Asthma Therapy to Improve Compliance in children) study by VASBINDER et al [12] reported in this issue of the European Respiratory Journal is a randomised controlled trial aimed at improving adherence to inhaled corticosteroid (ICS) therapy using information technology. Real-time medication monitoring (RTMM) was used to record the time and date of administered ICS doses.…”

“…VASBINDER et al [12] only focused on adherence in young children, aged 4-11 years. But poor adherence, and risk for severe asthma attacks, may be a much greater issue in adolescents.…”

They just don't take their medicines: Reframing medication adherence in asthma from frustration to opportunity

“…Importantly, while medication adherence may be improved by multiple intervention types, the links between improved adherence and many clinical outcomes remain unclear 35,71,78,87,88 . This may be due to the fact that asthma control is multifactorial and medication adherence is only one of the many factors that may affect day to day asthma control including triggers, environmental factors including tobacco smoke and pollution, and underlying asthma severity 35 .…”

“…Importantly, while medication adherence may be improved by multiple intervention types, the links between improved adherence and many clinical outcomes remain unclear. 35,71,78,87,88 This may be due to the fact that asthma control is multifactorial and medication adherence is only one of the many factors that may affect day to day asthma control including triggers, environmental factors including tobacco smoke and pollution, and underlying asthma severity. 35 In addition, optimal adherence is often defined by more than 80% medication usage, which is somewhat arbitrary, and actual optimal medication adherence levels may be patient-and diseasedependent 68 and future research is needed to establish "optimal adherence" in children with asthma.…”