Research background: Can a digital asthma monitor help with asthma medication adherence?
Children with asthma are typically prescribed a daily controller therapeutic regimen. Adherence to the asthma medication remains a problem, and day-to-day data is not provided through traditional methods of measuring adherence.
Researchers in the Breathing Institute at Children's Hospital Colorado sought to determine if it would be feasible to use commercially-available adherence monitoring sensors for children with severe asthma. They believed, if given the opportunity, patients and families would find the device easy to use and would continue to use it.
Research methods: Studying medication adherence in children with severe asthma
The study followed 25 children between the ages of 6 and 17 who were hospitalized at least once or visited the emergency room at least twice in the past year. Patients were followed for three months, and their providers were also asked to participate.
Digital health platform
The study included a medication adherence device, an online platform and a mobile application. The sensor was placed on the inhaler with a silicone cap. A mobile app accessed real time information about the child’s medication usage and included educational models and push notifications if the medication was not taken within 15 minutes of the designated time. Families with compatible smartphones received data on medication use. Families who did not have a compatible smartphone received a Bluetooth enabled hub for access to an online dashboard and emails. Providers were also enrolled in the system, received email notifications and could also log in to review their patient's information.
Patients and providers received two types of notifications:
- Decreased adherence (seven or more days of missed medications)
- Worsening asthma control status (increased use of rescue medications)
The study also consisted of surveys for enrolled patients and families: one halfway through the study and one three months after the study. Providers completed surveys at the time their first patient enrolled and then again at the time their last patient completed the study.
Study results: Asthma medication adherence increased with use of digital asthma monitors
Type of medication prescribed to participants:
- 24% fluticasone/salmeterol
- 28% mometasone/formoterol
- 48% fluticasone
Smartphone use by patients and families:
- 96% owned a smartphone
- 96% felt comfortable using a smartphone application
Digital health platform: patients
- 90% said the device was very easy or extremely easy to use
- 100% said the data from the application was very easy or somewhat easy to understand
- 85% said the data helped them learn about their child’s asthma
- 25% discussed the information with their provider
- 62.5% said the platform changed some aspect of their care
- 90% said they would recommend the device to a friend or family member
- 95% said they would continue to use it
Digital health platform: providers
Providers most frequently responded that communication with their patient changed. They also said there were changes in frequency of follow-ups and allergy assessments. Providers felt patients were more likely to take their medication with the device in place. They also reported that awareness of asthma trends, triggers and symptoms increased. Most felt the device changed some aspect of care for their patients.
56% average adherence (declined over the study period)
Research discussion: Asthma adherence monitoring in children
The digital health platform was well received by patients and providers. Future analysis of adherence monitoring devices should consider the different experience using a smartphone application compared to a Bluetooth hub (or other modality). Most of the providers in the study recommended adopting some form of the technology into their clinics. While adherence started high, it decreased over the study period, which is consistent with previous studies.
- Small sample size and control group
- Devices do not monitor technique, only adherence
- Short study period could have limited interactions with providers
The study authors conclude that it is feasible to use the technology to evaluate the effectiveness of interventions and to improve adherence to asthma medication use.
Future studies are underway or planned to:
- Find effective interventions to improve adherence
- Examine non-adherence phenotypes
- Examine the role of patient-provider communication for adherence and shared decision-making
- Determine which patients could benefit the most from adherence monitoring
Finally, study authors believe that digital health platforms will one day improve personalization of asthma medication therapy and give providers and patients the tools needed to improve the lives of children with asthma.
About the Breathing Institute
Our Breathing Institute provides comprehensive clinical care and consultation for children with common and complex breathing problems. Contact us at 720-777-6181.