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Does immediate smart feedback on therapy adherence and inhalation technique improve asthma control in children with
Esther T Sportel1, Martijn J Oude Wolcherink2, Job van der Palen3,4
1Department of Clinical Pharmacy, Medisch Spectrum Twente, Enschede, The Netherlands. e.sportel@mst.nl.
Insights
This study introduces smart feedback via a mobile app to improve medication adherence and inhaler technique in children with uncontrolled asthma. Immediate feedback aims to enhance asthma control and potentially prevent the need for advanced biologic therapies.
Area of Science:
- Pediatric Pulmonology
- Digital Health Interventions
- Asthma Management
Background:
- Uncontrolled asthma in children often stems from poor medication adherence and inhaler technique.
- Traditional methods for measuring these factors are limited.
- A new device offers real-time monitoring and feedback via a mobile app.
Purpose of the Study:
- To evaluate the effectiveness of immediate smart feedback in improving asthma control in children aged 6-18.
- To assess the impact on therapy adherence and inhalation technique.
- To explore the potential of this digital health tool in preventing escalation of asthma treatment.
Main Methods:
- A 3-phase study involving 68 children with moderate to severe uncontrolled asthma.
- Phase 1: 4-week observational period for baseline adherence and technique.
- Phase 2: 6-week randomized controlled trial comparing smart feedback group with a control group.
- Phase 3: 6-week follow-up with feedback cessation.
Main Results:
- Smart feedback is hypothesized to improve therapy adherence and inhalation technique.
- Improved adherence and technique are expected to lead to better asthma control.
- The study will measure asthma control using spirometry and (Childhood) Asthma Control Test ((c-)ACT) scores.
Conclusions:
- Immediate smart feedback shows potential to enhance asthma management in pediatric patients.
- This intervention may improve adherence and technique, leading to better asthma control.
- Digital health tools can play a crucial role in managing chronic pediatric conditions like asthma.
Background:
Many asthmatic children suffer from uncontrolled asthma with frequent exacerbations, despite an optimal treatment plan using inhalation medication. Studies have shown that therapy adherence and inhalation technique are often suboptimal in asthmatic children, but these have traditionally been hard to measure. A novel device functioning as an add-on to the inhaler has been developed to measure both aspects by recording vibration patterns during inhalation. This data can be converted to smart feedback and provided to patients immediately via a mobile application. The aim of this study is to improve asthma control in children between 6 and 18 years old by providing immediate smart feedback on the intake of inhalation medication. Asthma control will be measured by forced expiratory volume in 1 s, (Childhood) Asthma Control Test ((c-)ACT) score, and lung function variability and reversibility.
Methods:
The study will be performed in Medisch Spectrum Twente (Enschede, The Netherlands). The goal is to include 68 uncontrolled moderate to severe asthmatic children between 6 and 18 years old who receive controller inhalation medication through the Nexthaler®, Ellipta®, or Spiromax®. The study consists of three phases. Phase 1 is observational and will last 4 weeks to observe the baseline adherence and inhalation technique as monitored by the add-on device. A randomised controlled trial lasting 6 weeks will be performed in phase 2. Patients in the intervention group will receive immediate smart feedback about the performed inhalations via a mobile application. In the control group, adherence and inhalation technique will be monitored, but patients will not receive feedback. In phase 3, also lasting 6 weeks, the feedback will be ceased for all children and revision of current therapy may occur, depending on the findings in phase 2. Asthma control can be assessed by means of spirometry (both at home and in the hospital) and (c-)ACT questionnaires.
Discussion:
Immediate smart feedback may improve therapy adherence and inhalation technique, and thus asthma control in children and prevent unnecessary switches to targeted biologics. Performing this study in children is desired, since they are known to react differently to feedback and medication than adults.
Trial Registration:
Dutch Trial Register NL7705 . Registered on 29 April 2019.
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