Electronic Medication Monitoring vs. Self-Reported Use of Inhaled Corticosteroids and Short Acting Beta2 Agonists in Adult Patients with Uncontrolled Asthma

Abstract

For patients with asthma, self-reported inhaled corticosteroid (ICS) adherence and Short Acting Beta 2 Agonist (SABA) use may be inaccurate. This may lead to inappropriate clinical decision-making, keep patients from achieving their treatment goals and adversely impact healthcare costs. This study compares self-reported ICS and SABA use with objective data from electronic medication monitors (EMM). METHODS: Adults with uncontrolled asthma (defined by Asthma Control Test Scores of <19 and/or NHLBI NAEPP EPR3 guideline criteria) and prescribed ICS and SABA by their asthma specialist (allergist/immunologist/pulmonologist) were enrolled. At visit one, participants' ICS and SABA inhalers were fitted with EMMs (Propeller Health, Madison, WI) to track real-time medication usage over 14 days. Participants were asked to complete paper diaries to self-report medication usage over the same period. Self-reported vs. objective ICS adherence and SABA use was compared using paired t-tests and Wilcoxon signed-rank tests. RESULTS: One hundred participants (80% female, mean age 48.5 years, 60% completed college, 80% privately insured) had complete data. Selfreported mean (standard deviation) daily ICS adherence (79% [31]) and median (interquartile range) SABA use (0.7 puffs [0-1.9]) was higher than objectively measured ICS adherence (69% [29], P50.01) and SABA use (0.3 puffs [0.1-1.1], P<0.001). CONCLUSIONS: There was significant over-reporting of inhaler use, which may result in inappropriate changes to therapy and medication regimen complexity. Use of EMMs can increase the accuracy of medication usage reporting and allow healthcare providers to make more informed clinical decisions for patients.