Feedback on inhaler use does not significantly improve inhaled corticosteroid adherence or clinical outcomes

Abstract

Background: Studies suggest interventions using electronic monitoring devices (EMDs) improve inhaled corticosteroid (ICS) adherence. Evidence of their impact on clinical outcomes remains inconclusive with only two studies in children and one in adults demonstrating a potential change in clinical outcomes in response to EMD-based interventions.

Aims and Objectives: A pilot study was conducted to investigate the feasibility of using EMD-based feedback to participants as an intervention to improve adherence and clinical outcomes.

Methods: Participants with doctor-diagnosed asthma reporting an exacerbation in the preceding 12 months were recruited for a randomised controlled study. All participants were issued with EMDs for six months. Asthma control, quality of life and exacerbation data were collected monthly with intervention participants additionally receiving adherence feedback.

Results: 36 participants (67% female, median age 48 years) were randomised. Data were obtained from 18 intervention and 15 control participants. Intervention participants had a mean daily ICS adherence of 70.7% versus 59.4% in the control group. This difference was not statistically significant (p=0.319). There was no significant difference in clinical outcomes although there was a borderline significant increase in intervention group exacerbation rate (p= 0.069).

Conclusion: This study did not find EMD-based feedback to significantly improve ICS adherence or clinical outcomes. It suggests factors related to current definitions of exacerbation may confound the interaction between EMD interventions, adherence and outcomes. Future studies should combine EMD-based feedback with other modes of intervention.