RT Journal Article
SR Electronic
T1 A randomised clinical trial of feedback on inhaler adherence and technique in patients with severe uncontrolled asthma
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 1701126
DO 10.1183/13993003.01126-2017
VO 51
IS 1
A1 Imran Sulaiman
A1 Garrett Greene
A1 Elaine MacHale
A1 Jansen Seheult
A1 Matshediso Mokoka
A1 Shona D'Arcy
A1 Terence Taylor
A1 Desmond M. Murphy
A1 Eoin Hunt
A1 Stephen J. Lane
A1 Gregory B. Diette
A1 J. Mark FitzGerald
A1 Fiona Boland
A1 Aoife Sartini Bhreathnach
A1 Breda Cushen
A1 Richard B. Reilly
A1 Frank Doyle
A1 Richard W. Costello
YR 2018
UL http://erj.ersjournals.com/content/51/1/1701126.abstract
AB In severe asthma, poor control could reflect issues of medication adherence or inhaler technique, or that the condition is refractory. This study aimed to determine if an intervention with (bio)feedback on the features of inhaler use would identify refractory asthma and enhance inhaler technique and adherence.Patients with severe uncontrolled asthma were subjected to a stratified-by-site random block design. The intensive education group received repeated training in inhaler use, adherence and disease management. The intervention group received the same intervention, enhanced by (bio)feedback-guided training. The primary outcome was rate of actual inhaler adherence. Secondary outcomes included a pre-defined assessment of clinical outcome. Outcome assessors were blinded to group allocation. Data were analysed on an intention-to-treat and per-protocol basis.The mean rate of adherence during the third month in the (bio)feedback group (n=111) was higher than that in the enhanced education group (intention-to-treat, n=107; 73% versus 63%; 95% CI 2.8%–17.6%; p=0.02). By the end of the study, asthma was either stable or improved in 54 patients (38%); uncontrolled, but poorly adherent in 52 (35%); and uncontrolled, but adherent in 40 (27%).Repeated feedback significantly improved inhaler adherence. After a programme of adherence and inhaler technique assessment, only 40 patients (27%) were refractory and adherent, and might therefore need add-on therapy.On a period of monitored adherence only 27% of patients were refractory and adherent and thus need add-on therapy http://ow.ly/ddQr30gTpmb