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Electronic monitoring of adherence to inhaled corticosteroids: an essential tool in identifying severe asthma in children

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Title: Electronic monitoring of adherence to inhaled corticosteroids: an essential tool in identifying severe asthma in children
Authors: Jochmann, A
Artusio, L
Jamalzadeh, A
Nagakumar, P
Delgado-Eckert, E
Saglani, S
Bush, A
Frey, U
Fleming, LJ
Item Type: Journal Article
Abstract: International guidelines recommend that severe asthma can only be diagnosed after contributory factors, including adherence, have been addressed. Accurate assessment of adherence is difficult in clinical practice. We hypothesised that electronic monitoring in children would identify nonadherence, thus delineating the small number with true severe asthma.Asthmatic children already prescribed inhaled corticosteroids were prospectively recruited and persistence of adherence assessed using electronic monitoring devices. Spirometry, airway inflammation and asthma control were measured at the start and end of the monitoring period.93 children (62 male; median age 12.4 years) were monitored for a median of 92 days. Median (range) monitored adherence was 74% (21-99%). We identified four groups: 1) good adherence during monitoring 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%. No clinical parameter prior to monitoring distinguished these groups.Electronic monitoring is a useful tool for identifying children in whom a step up in treatment is indicated. Different approaches are needed in those who are controlled when adherent or who are nonadherent. Electronic monitoring is essential in a paediatric severe asthma clinic.
Issue Date: 21-Dec-2017
Date of Acceptance: 19-Sep-2017
URI: http://hdl.handle.net/10044/1/55720
DOI: https://dx.doi.org/10.1183/13993003.00910-2017
ISSN: 0903-1936
Publisher: European Respiratory Society
Journal / Book Title: European Respiratory Journal
Volume: 50
Issue: 6
Copyright Statement: © ERS 2017. This is an author-submitted, peer-reviewed version of a manuscript that has been accepted for publication in the European Respiratory Journal, prior to copy-editing, formatting and typesetting. This version of the manuscript may not be duplicated or reproduced without prior permission from the copyright owner, the European Respiratory Society. The publisher is not responsible or liable for any errors or omissions in this version of the manuscript or in any version derived from it by any other parties. The final, copy-edited, published article, which is the version of record, is available without a subscription 18 months after the date of issue publication.
Sponsor/Funder: Asthma UK
Asthma UK
Funder's Grant Number: AUK-IG-2014-284
R43065
Keywords: 11 Medical And Health Sciences
Respiratory System
Publication Status: Published online
Conference Place: England
Article Number: 1700910
Appears in Collections:National Heart and Lung Institute
Faculty of Medicine



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