Electronic adherence monitoring devices for children with asthma: A systematic review and meta-analysis of randomised controlled trials
Related Experiment Video
Updated: Oct 24, 2025
Conducting Respiratory Oscillometry in an Outpatient Setting
Published on: April 8, 2022
Jing Ru Lee1, Siyan Leo2, Suyue Liao3
1Nursing Department, Dover Park Hospice, Singapore.
Insights
Electronic adherence monitoring devices significantly improved inhaler adherence in children with asthma. While user-friendly, these devices did not impact asthma exacerbations or lung function, suggesting future improvements are needed.
Area of Science:
- Pediatric Pulmonology
- Digital Health Interventions
- Medication Adherence Research
Background:
- Childhood asthma is a prevalent chronic condition.
- Poor medication adherence in children with asthma leads to increased exacerbations, school absenteeism, and healthcare costs.
- Electronic adherence monitoring devices show promise for improving medication adherence in pediatric asthma patients.
Purpose of the Study:
- To evaluate the effectiveness of electronic adherence monitoring devices in enhancing inhaler adherence among children diagnosed with asthma.
Main Methods:
- A systematic review and meta-analysis of randomized controlled trials.
- Searched multiple databases (Cochrane Library, PubMed, Embase, etc.) up to April 2021.
- Included 10 trials with 1123 participants, analyzing inhaler adherence, asthma exacerbations, lung function, and asthma control.
Main Results:
- Electronic adherence monitoring devices increased inhaler adherence by 1.50 times (g=0.64) compared to controls.
- Devices were user-friendly with high accessibility, but no significant differences were found in asthma exacerbations, lung function, or asthma control.
- Subgroup analyses revealed no significant differences based on device features or patient populations.
Conclusions:
- Electronic adherence monitoring devices can effectively improve inhaler adherence in children with asthma.
- Future devices should incorporate actuation and inhalation monitoring for comprehensive assessment.
- High-quality, large-scale trials are recommended prior to widespread clinical adoption.
Background:
Asthma is a common chronic condition amongst children. Poor adherence to asthma medications can increase asthma exacerbations, absence from school, healthcare utilisation and costs and decrease quality of life. Emerging evidence suggests the use of electronic adherence monitoring devices in improving children's adherence to medications.
Objectives:
This study aimed to evaluate the effectiveness of electronic adherence monitoring devices in improving inhaler adherence amongst children with asthma.
Design:
This study is a systematic review and meta-analysis.
Data Sources:
A systematic search using Cochrane Library, PubMed, Embase, CINAHL, Web of Science, Scopus and ProQuest Dissertations and Theses from inception up to April 6, 2021, was conducted.
Review Methods:
Randomised controlled trials evaluating the use of electronic adherence monitoring devices amongst children and published in English were included. The outcomes were inhaler adherence, asthma exacerbation, lung function, asthma control and accessibility. The overall effect was measured using Hedges' g and determined using Z-statistics at a significance level of p < 0.05. Heterogeneity was assessed using χ2 and I² statistics. The individual and overall quality of evidence was assessed. Sensitivity and subgroup analyses were conducted. Narrative synthesis of outcomes was performed when meta-analysis could not be conducted on the data.
Results:
A total of 13,429 records were identified, and 10 randomised controlled trials in 11 articles amongst 1123 participants were included in the meta-analysis. Meta-analysis revealed that the electronic adherence monitoring device group was 1.50 times more likely to adhere to inhalers compared with the control group with medium-to-large effect size (g = 0.64). A series of subgroup analyses showed that no significant subgroup differences for inhaler adherence were found amongst different populations, comparator, setting, duration of the monitoring period, reminder, and feedback functions of the electronic adherence monitoring devices. Children found the devices as user friendly with high accessibility scores. However, no significant differences were observed between the intervention and control groups for asthma exacerbations, lung function and asthma control.
Conclusions:
The findings from this study suggested that electronic adherence monitoring devices could improve inhaler adherence. Future devices should contain actuation and inhalation functions that can help to confirm actual inhalation amongst children with asthma. The overall evidence of outcomes ranged from very low to high. Furthermore, future large-scale trials were recommended before clinical implementations.
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