Sensor-Based Electronic Monitoring for Asthma: A Randomized Controlled Trial

Abstract

BACKGROUND: Although sensor-based monitoring of daily inhaled corticosteroids (ICSs) and short-acting β-agonist medications may improve asthma outcomes, the effectiveness of these interventions in diverse pediatric populations remains unclear. METHODS: Caregiver and child dyads were randomly assigned to receive inhaler sensors that allowed for caregiver and clinician electronic monitoring of medications. End points included Asthma Control Test scores (>19 indicated asthma control) and asthma health care use. Caregiver quality of life (QoL) and child ICS adherence were also assessed. Multilevel models were used to estimate adjusted changes from baseline. RESULTS: Dyads were assigned to the control (n = 127) or intervention (n = 125) arms. At the end line, the mean Asthma Control Test score increased from 19.1 (SE = 0.3) to 21.8 (SE = 0.4) among the intervention and from 19.4 (SE = 0.3) to 19.9 (SE = 0.4) among the control (Δintervention-control = 2.2; SE = 0.6; P < .01). Adjusted rates of emergency department visits and hospitalizations among the intervention were significantly greater (incidence rate ratioemergency department = 2.2; SE = 0.5; P < .01; incidence rate ratiohospital = 3.4; SE = 1.4; P < .01) at endline than the control. Caregiver QoL was greater among the intervention at the endline (Δintervention-control = 0.3; SE = 0.2; P = .1) than the control. CONCLUSIONS: Findings suggest that sensor-based inhaler monitoring with clinical feedback may improve asthma control and caregiver QoL within diverse populations. Higher health care use was observed among the intervention participants relative to the control, indicating further refinement is warranted.

Parent Experiences With Electronic Medication Monitoring in Pediatric Asthma Management: Qualitative Study

“…We recruited parents from the intervention arm of the Improving Technology-Assisted Recording of Asthma Control in Children (iTRACC) trial for interviews [ 15 ]. In the original trial, caregiver and child dyads were eligible if the following criteria were met: (1) child was aged 4 to 17 years; (2) child had experienced at least one asthma exacerbation requiring oral corticosteroids in the year prior to enrollment; and (3) parent reported active prescription of an ICS or combination ICS–long-acting beta-agonist (ICS-LABA) for at least 1 year prior to enrollment.…”

“…The iTRACC trial involved a multicomponent health intervention that included (1) Bluetooth-enabled sensors placed on inhaler medications that paired with the parent’s smartphone via a mobile app (Propeller Health), and (2) monitoring through a web portal and follow-up phone calls by clinic staff [ 15 , 18 ] ( Figure 1 ). The EMM technology tracked the use of most ICSs, short-acting beta-agonists (SABAs), and combination ICS-LABAs that were available on the US market.…”

“…We present findings that explored the use of EMM by parents in a 12-month intervention trial embedded in outpatient pediatric practices. The trial studied the effects of EMM via Bluetooth-enabled inhaler sensors, accompanied by a mobile app in pediatric asthma management [ 15 ]. Sensors tracked daily inhaler medication usage, which parents and clinicians could monitor.…”

The applications of eHealth technologies in the management of asthma and allergic diseases

“… 60 An electronic monitoring sensor attached to inhalers has proven to increase asthma control in paediatric patients, as well as caregivers quality of life. 61 A multi‐centre observational study concluded that a gamification strategy using a mobile app could be useful to monitor adherence to asthma medication. 62 Additionally, patients’ feedback on these devices has also been described to be positive.…”

“…A recent observational study described a 14.5% increase in inhalers adherence by using digital trackers among patients with asthma and COPD during the COVID‐19 pandemic 60 . An electronic monitoring sensor attached to inhalers has proven to increase asthma control in paediatric patients, as well as caregivers quality of life 61 . A multi‐centre observational study concluded that a gamification strategy using a mobile app could be useful to monitor adherence to asthma medication 62 .…”