Sensor-Based Electronic Monitoring for Asthma: A Randomized Controlled Trial

Abstract

To assess whether sensor-based monitoring of daily inhaled corticosteroids and short-acting b-agonist medications can improve asthma outcomes in diverse populationsA socioeconomically and racially diverse population of caregiver and children dyads were randomly assigned to control (n = 127) or sensor-based electronic monitoring (n = 125) for asthma.This was a randomized controlled multicenter trial of socioeconomically and racially diverse caregiver and children pairs from 5 Chicago medical clinics. The primary outcomes measured were the Asthma Control Test (ACT) (≥19 score equivalent to controlled asthma) and health care use (emergency department visits, hospitalizations, and oral corticosteroid prescriptions). Caregiver quality of life (QoL) and adherence to inhaled corticosteroids were also evaluated with multitiered models to ascertain changes.The intervention group had a significant increase in adjusted mean ACT scores (19.1 [n = 123; SE = 0.3] to 21.8 [n = 102; SE = 0.4]). The control group also had an increase in adjusted mean ACT scores (19.4 [n = 126; SE = 0.3] to 19.9 [n = 118; SE = 0.4]), the change was less than that of the intervention group at all time points (P < .01 for all comparisons). There was no difference in terms of the reported number of asthma attacks, missed school days, and steroid prescriptions in the ED and/or hospital. However, more children in the intervention group were prescribed steroids for asthma attacks during the 12 month study than controls were (72.5% intervention versus 34.6% control; P < .01). Improved QoL was reported by caregivers of the intervention group; this change was greater that of seen in the control group at 1 month follow-up, but there was no difference at 12 months.The outcomes of the study reveal that sensor-based inhaler monitoring with clinical participant–provider feedback may enhance asthma control and caregiver QoL in racially and socioeconomically diverse populations. However this improvement in outcomes for child and caregiver comes at the price of higher health care use, so further improvement in the sensor and participant–provider feedback system is needed.The authors should be recognized for demonstrating that use of sensor monitoring for asthma medications in children can improve asthma control and caregiver QoL in diverse populations. However, these improvements may come at a price of increasing health care use (steroid prescriptions). The limitations of the study include that data had to be manually entered because the blue chip device did not fit the inhaler and the absence of documentation or quantification of participant–provider phone feedback and adherence in both study groups as well as cost-effectiveness analysis.