Mobile video directly observed therapy can be used to improve at-home inhaler technique in children with asthma

Abstract

We were very pleased to read the article “Comparison of inhalation technique with the Diskus and Autohaler in asthmatic children at home”, recently published in ERJ Open Research [1]. In that paper, the authors describe using video Directly Observed Therapy (vDOT) to detect children's errors when using their inhalers at home. This is very important, and clearly shows that paediatricians and asthma specialists can wrongly assume that if a child can demonstrate correct inhaler technique in the clinic, they will continue to use correct inhaler technique when at home. The authors also report that errors were more frequent when the dry-powder Diskhaler was compared with the Autohaler.

Medication Adherence in Children with Asthma

“…Many patients with on-going severe problem asthma improve their asthma control when the essentials of asthma care are in place (full understanding and action of PAAP, correct adherence to preventer therapy, correct inhaler technique along with trigger avoidance) and a period of optimised medication has been delivered. 9 , 10 Patients failing to respond to a period of optimised therapy have Severe Treatment Resistant Asthma (STRA). For such patients, new biologic agents (namely, monoclonal antibodies to various inflammatory pathways such as IgE and Interleukins including anti-iL5 and Il4/IL13) have proven efficacy in reducing asthma exacerbation rates.…”

“…In fact, in the 48 months before the full implementation of vDOT in the study site facility, some 17 children with asthma were escalated to biologicals, while over the 48 months with vDOT implemented that number had dropped to two patients. 10 …”

The use of remote video directly observed therapy to improve both inhaler technique and adherence to asthma medications

“…Based on the success of DOT, remote methods of delivering this approach have been developed to increase its scalability. The use of video directly observed therapy (vDOT), which involves a patient taking a video (usually taken using a mobile phone) of themselves taking their medication and submitting it for review by a healthcare professional, is now endorsed by the World Health Organization for the management of TB ( 12 , 13 ).…”

“…The use of vDOT at the regional DTA clinic has significantly reduced the number of children requiring step up to expensive biologic therapies for asthma (such as anti-IgE and anti-IL5 therapies). In the 48 months before the full implementation of vDOT, some 17 asthma children within Northern Ireland were escalated to biologic therapies, while over the 48 months with vDOT implemented, that number had dropped to two patients ( 12 ).…”

“…In addition, the RBHSC team use vDOT to facilitate the FeNO suppression test ( 12 ). The FeNO suppression test is a tool which can help detect non-adherence to ICS as the cause of poor asthma control.…”