Improvement in asthma control and airway inflammation during a period of electronic monitoring

Abstract

Introduction: Correctly identifying children with poor adherence can avoid unnecessary escalation of treatment and enable a targeted adherence intervention.

Aims: To compare self-assessment of adherence in children with difficult asthma (DA) with adherence measured electronically and assess changes in asthma control during monitoring.

Methods: DA patients were given an electronic device, Smartinhaler, which records ICS actuations. Self-assessed adherence was measured using Medicine Adherence Rating Scale (MARS) (Cohen 2009, Ann.Allergy Immunol). High scores reflect good self-assessed adherence. Poor adherence was defined as <80% monitored ICS use. Lung function, inflammation and asthma control were measured at baseline (BL) and follow up (FU) 12-16 weeks later.

Results: 50 children (33 male) median age 12.4 (range 5-17) years were included. Median Smartinhaler adherence was 60% (range 24-97%). MARS score was unrelated to Smartinhaler adherence. 33/50 (66%) with Smartinhaler adherence <80% had median MARS score of 24/25. FEV₁ and mPAQLQ improved significantly following monitoring (Table 1). FENO also improved significantly in those with Smartinhaler adherence >80%.

Conclusion: Despite monitoring most participants had sub-optimal adherence, not detected by MARS scores. Improvements in FENO, FEV₁ and mPAQLQ likely reflect increased adherence during monitoring.