Novel electronic adherence monitoring devices in children with asthma: a mixed-methods study

Abstract

IntroductionAdherence monitoring to inhaled corticosteroids is an essential component of asthma management. Electronic monitoring devices (EMD) provide objective data on date, time and number of actuations. However, most give no information on inhalation. Novel EMD (NEMD) platforms have the potential to monitor both activation and inhalation.AimTo assess the feasibility of NEMDs, in terms of usability, acceptability to patients and healthcare professionals and accuracy.MethodsThis was an open-label, prospective, mixed-methods, pragmatic randomised study. Children with asthma attending specialist tertiary care were randomised to one of four NEMD: Remote Directly Observed Therapy (R-DOT), Hailie Smartinhaler, INhaler Compliance Assessment device (INCA) and the Rafi-tone App. Following monitoring, participants were invited to focus groups or one-to-one interviews. Usability and acceptability were evaluated using themes identified from the focus groups and interviews. Adherence accuracy was determined using adherence data from each NEMD.ResultsThirty-five children were recruited; 18 (51%), (11 males, median age 13.5 (7–16) years) completed monitoring, 14 (78%) provided feedback. Participants identified various features such as ease of use and minimal effort as desirable criteria for an NEMD. The Hailie and INCA fulfilled these criteria and were able to record both actuation and inhalation. Negative themes included a ‘Big Brother’ effect and costs.ConclusionThere was no ‘one size fits all’, as participants identified advantages and disadvantages for each NEMD. Devices that can easily calculate adherence to activation and inhalation have the potential to have greatest utility in clinical practice. Each NEMD has different functionality and therefore choice of platform should be determined by the needs of the patient and healthcare professional.

Feasibility of video observed therapy to support controller inhaler use among children in West Baltimore

“…Next, video submission was used as a proxy for ICS adherence, which may have underestimated adherence if patients used their inhaler without capturing a video. Nonetheless, we found at least 68% ICS adherence among our sub-cohort, which is consistent with previous video DOT studies (31,32) and well above national estimates of 50% adherence among children. Finally, the COVID-19 pandemic introduced a significant confounder, precluding reliable assessment of clinical outcomes and potentially influencing secondary outcomes.…”

“…The analysis of preliminary program outcomes suggests potential program efficacy. We found relatively high ICS adherence of 68%, which is consistent with prior studies reporting 73% adherence using video DOT among children (31,32). We also observed significantly improved inhaler technique and found a strong positive correlation between program engagement and mastery of inhaler technique.…”

“…However, these studies have primarily focused on oral anti-tuberculosis treatment in adults. Our study is generally consistent with the few studies reporting high feasibility and acceptability of video DOT among children, including two studies that assessed asthma inhaler use (29)(30)(31)(32). To our knowledge, this is the first to assess a comprehensive pediatric asthma program combining video DOT-based monitoring of inhaler use with delivery of a multi-component intervention.…”

“…Mobile applications (app) supporting video DOT are recommended by the World Health Organization for monitoring patients taking anti-tuberculosis treatment (28) and have been implemented among children receiving treatment for tuberculosis and sickle cell anemia, but have not been extensively used for inhaler use in adults or children (29)(30)(31). As of this writing, two small studies report high feasibility and acceptability of using video DOT to monitor inhaler use in children (31,32). A comprehensive digital program combining video DOT with a multi-component intervention has not been evaluated.…”

Digital Inhalers for Asthma or Chronic Obstructive Pulmonary Disease: A Scientific Perspective

“…Data gathered using digital inhalers on patients' medication adherence, particularly when supported with information on symptoms, physiological measures, and environmental conditions, can provide a more complete basis for timely and personalized decisions about management [10][11][12]. The potential to improve patient care with digital inhalers has been significantly enhanced by incorporating newer technology into these devices such as the ability to record location data of the inhaler and to provide real-time feedback on the inhalation technique [10,[13][14][15].…”