Short-term effect of a smart nebulizing device on adherence to inhaled corticosteroid therapy in Asthma Predictive Index-positive wheezing children

Zhou, Yuan; Lu, Yanming; Zhu, Haojin; Zhang, Yanhan; Li, Yaqin; Yu, Qing

doi:10.2147/ppa.s162744

Cited by 12 publications

(9 citation statements)

References 27 publications

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“…Together, these studies suggest that home nebulisation of ICS therapy may facilitate a more rapid improvement in asthma control compared to other methods. The type of nebulizer used may also impact adherence and e cacy; our ndings complement those of Zhou et al, who demonstrated that using a 'smart' nebulizer incorporating electronic monitoring to administer ICS therapy resulted in higher adherence rates and signi cantly improved clinical outcomes compared to conventional nebulizer use [17].…”

Section: Discussionsupporting

confidence: 81%

“…In the present study, the median treatment adherence rate reported by portable home nebulizer devices was 69.9%, which compares favourably to many previous reports among children in other regions worldwide: the median electronically monitored adherence was 58.4% and 46%, respectively, in two studies in the USA [6,12,13], changing from 54% and 41% at Month 4 to 47% and 31.5% at Month 12 in patients with controlled and uncontrolled asthma, respectively, in a study from Brazil [14], and 49.5% in a study from The Netherlands [15]. Results of the present study also compared favourably to other studies in China investigating treatment adherence in patients with asthma (adults or children) [16][17][18]. Furthermore, the World Health Organization reported that mean adherence was approximately 50% based on key studies in adults and children [19].…”

Section: Discussionsupporting

confidence: 65%

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CARE: An Observational Study of Adherence to Home Nebulizer Therapy Among Children with Asthma

Zhao

Chen

et al. 2020

Preprint

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Abstract Background The prevalence of pediatric asthma in China is approximately 3%, and asthma remains poorly controlled in many of these patients. This study assessed the rate of adherence to home nebulizer treatment in pediatric patients in China.Methods The CARE study was a 12-week, multicentre, prospective, observational study across 12 tertiary hospitals in China. Patients were aged 0–14 years, clinically diagnosed with asthma and prescribed home nebulizer inhaled corticosteroid (ICS) therapy for ³ 3 months. The primary endpoint was electronically monitored treatment adherence. Patients attended onsite visits at 0, 4, 8 and 12 weeks to assess asthma control, severity and treatment adherence (recorded by electronic monitoring devices and caregivers).Results The full analysis set included 510 patients. Median treatment adherence reported by electronic monitoring devices was 69.9%, and median caregiver-reported adherence was 77.9%. The proportion of patients with well-controlled asthma increased from 12.0% at baseline to 77.5% at Visit 4. Increased time between asthma diagnosis and study enrolment was a significant predictor for better adherence (coefficient: 0.01 [p = 0.0138, 95% confidence interval: 0.00, 0.01]) and asthma control (odds ratio = 1.001, p = 0.0498, 95% CI: 1.000, 1.002). Negative attitude to treatment by the caregiver was associated with poorer asthma control.ConclusionsAdherence to home nebulization, a widely-used treatment for asthma, was high among Chinese pediatric patients. Asthma control improved with increasing treatment duration. These results suggest that home nebulization of ICS is an effective and recommendable long-term treatment for pediatric patients with asthma. Trial registrationClinicalTrials.gov, NCT03156998.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionsupporting

confidence: 65%

CARE: An Observational Study of Adherence to Home Nebulizer Therapy Among Children with Asthma

Zhao

Chen

et al. 2020

Preprint

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“…Also, the original API was used to explore the effect of a smart nebulizing device on the rate of adherence to ICS in Chinese preschoolers with positive API ( n = 65), showing a significant improve in the rate of adherence, and reducing the frequency of emergency visits and respiratory infections, as well as the usage of antibiotics or systemic steroids (34). A recent study (35) in Chinese Han preschoolers ( n = 385) reported association of four-gene model consisting of IL13 rs20541, IL4 rs2243250, ADRB2 rs1042713, and FCER1B rs569108 with the original API [OR = 4.08, p < 0.0001; and OR = 2.36, p < 0.0001, for stringent and loose API, respectively].…”

Section: Predictive Models For Prognostic or Diagnostic Toolsmentioning

confidence: 99%

Predicting Asthma Using Clinical Indexes

2019

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Asthma is no longer considered a single disease, but a common label for a set of heterogeneous conditions with shared clinical symptoms but associated with different cellular and molecular mechanisms. Several wheezing phenotypes coexist at preschool age but not all preschoolers with recurrent wheezing develop asthma at school-age; and since at the present no accurate single screening test using genetic or biochemical markers has been developed to determine which preschooler with recurrent wheezing will have asthma at school age, the asthma diagnosis still needs to be based on clinical predicted models or scores. The purpose of this review is to summarize the existing and most frequently used asthma predicting models, to discuss their advantages/disadvantages, and their accomplishment on all the necessary consecutive steps for any predictive model. Seven most popular asthma predictive models were reviewed (original API, Isle of Wight, PIAMA, modified API, ucAPI, APT Leicestersher, and ademAPI). Among these, the original API has a good positive LR~7.4 (increases the probability of a prediction of asthma by 2–7 times), and it is also simple: it only requires four clinical parameters and a peripheral blood sample for eosinophil count. It is thus an easy model to use in any rural or urban health care system. However, because its negative LR is not good, it cannot be used to rule out the development of asthma.

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“…The type of nebulizer used may also impact adherence and efficacy; our findings complement those of Zhou et al, who demonstrated that using a 'smart' nebulizer incorporating electronic monitoring to administer ICS therapy resulted in higher adherence rates and significantly improved clinical outcomes compared with conventional nebulizer use. 19 Uni-and multivariate analyses showed that increased time between diagnosis and study enrolment was a significant predictor of good asthma control. We also found that a negative caregiver attitude was associated with poorer asthma control, perhaps due to a reduced treatment adherence or less care being taken when using the nebulizer.…”

Section: Discussionmentioning

confidence: 98%

CARE: an observational study of adherence to home nebulizer therapy among children with asthma

Zhao

Chen

et al. 2021

Ther Adv Respir Dis

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Background: The prevalence of pediatric asthma in China is approximately 3%, and asthma remains poorly controlled in many of these patients. This study assessed the rate of adherence to home nebulizer treatment in paediatric patients in China. Methods: The CARE study was a 12-week, multicentre, prospective, observational study across 12 tertiary hospitals in China. Patients were aged 0–14 years, clinically diagnosed with asthma and prescribed home nebulizer inhaled corticosteroid (ICS) therapy for ⩾3 months. The primary endpoint was electronically monitored treatment adherence. Patients attended onsite visits at 0, 4, 8 and 12 weeks to assess asthma control, severity and treatment adherence (recorded by electronic monitoring devices and caregivers). Results: The full analysis set included 510 patients. Median treatment adherence reported by electronic monitoring devices was 69.9%, and median caregiver-reported adherence was 77.9%. The proportion of patients with well-controlled asthma increased from 12.0% at baseline to 77.5% at visit 4. Increased time between asthma diagnosis and study enrolment was a significant predictor for better adherence [coefficient: 0.01, p = 0.0138; 95% confidence interval (CI): 0.00, 0.01] and asthma control (odds ratio = 1.001, p = 0.0498; 95% CI: 1.000, 1.002). Negative attitude to treatment by the caregiver was associated with poorer asthma control. Conclusions: Adherence to home nebulization, a widely used treatment for asthma, was high among Chinese pediatric patients. Asthma control improved with increasing treatment duration. These results suggest that home nebulization of ICS is an effective and recommendable long-term treatment for paediatric patients with asthma. Trial registration ClinicalTrials.gov identifier: NCT03156998 The reviews of this paper are available via the supplemental material section.

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Short-term effect of a smart nebulizing device on adherence to inhaled corticosteroid therapy in Asthma Predictive Index-positive wheezing children

Cited by 12 publications

References 27 publications

CARE: An Observational Study of Adherence to Home Nebulizer Therapy Among Children with Asthma

CARE: An Observational Study of Adherence to Home Nebulizer Therapy Among Children with Asthma

Predicting Asthma Using Clinical Indexes

CARE: an observational study of adherence to home nebulizer therapy among children with asthma

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