Electronic Monitoring of Adherence to Inhaled Corticosteroids: An Essential Tool in Identifying Severe Asthma in Children

Abstract

To study if electronic monitoring could be used to separate patients with severe asthma with poor control. In addition, the purpose was to observe if electronic monitoring would lead to the optimization of standard asthma therapy.This was a prospective observational cohort of children aged 5 to 17 years. The study included 108 children with asthma recruited from the outpatient department of Royal Brompton Hospital in London, United Kingdom.All children had an asthma diagnosis by standard protocols. Children were classified into 3 groups: severe therapy-resistant asthma, difficult asthma, and mild-to-moderate asthma. Baseline and end–of–monitoring period assessments included an asthma control test, lung function, fractional exhaled nitric oxide, asthma-related quality of life, and medication adherence using a smart inhaler.Data for 93 children who completed the study were analyzed. The median days of monitoring was 92. Good adherence was found in 42% of patients who took ≥80% of medications. Suboptimal adherence was noted in 58% of patients (27% took 60%–79% of medications, and 31% took <60% of medications). No significant differences were seen between the adherence groups for the asthma control test, fractional exhaled nitric oxide, forced expiratory volume in 1 second, the exacerbation rate, or oral corticosteroid use. Four groups were identified after the data analysis: (1) good adherence with improved control (24%; likely previous poor adherence), (2) good adherence with poor control (18%; severe therapy-resistant asthma), (3) poor adherence with good control (26%; likely overtreated), and (4) poor adherence with poor control (32%).This study revealed the importance of accurate adherence monitoring in children with asthma. Suboptimal adherence was noted in 58% of patients despite knowing that adherence was being monitored. The authors of this study identified patients with true severe asthma despite good adherence to therapy, suggesting that patients would merit further phenotyping of their asthma. In the study, researchers also confirmed the inadequacy of self-reported adherence and the limitation of prescription records.Not surprisingly, 58% of the study patients had suboptimal adherence. This represents real-world data and the difficulty with asthma adherence despite education, monitoring, and routine follow-up. This study also reveals that electronic monitoring could be helpful in identifying poor adherence as a cause of asthma poor control. Therefore, for some, improved education may be more beneficial than prescribing more medications.