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Mobile Direct Observed Therapy (MDOT) for Inhaler Therapy in Children With Newly Diagnosed Asthma: A Pilot Study
Amit Pathania1, Kana Ram Jat2, Meenakshi Pathania3
1Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India and Department of Pediatrics, Base Hospital Delhi Cantt, New Delhi, India.
Insights
Mobile Direct Observed Therapy (MDOT) using WhatsApp was well accepted by parents of children with asthma. This approach significantly improved the metered dose inhaler with spacer technique in children.
Area of Science:
- Pediatric Pulmonology
- Digital Health Interventions
- Asthma Management
Background:
- Asthma is a common chronic respiratory disease in children.
- Correct inhaler technique is crucial for effective asthma management.
- Traditional direct observed therapy can be resource-intensive.
Purpose of the Study:
- To evaluate the acceptability of Mobile Direct Observed Therapy (MDOT) among parents of children with asthma.
- To assess the impact of MDOT on the correctness of the metered dose inhaler with spacer (MDI-S) technique.
- To explore caregivers' perceptions and feedback on MDOT.
Main Methods:
- An open-label pilot randomized controlled trial was conducted with 30 newly diagnosed children (aged 5-15 years) with asthma.
- The intervention group used MDOT, recording and sharing MDI-S technique videos via WhatsApp for feedback.
- The control group received standard telephonic follow-up for six weeks.
Main Results:
- MDOT was highly accepted, with 86% of parents uploading good-quality videos.
- The average number of incorrect MDI-S steps significantly decreased from 2.64 to 0 in the MDOT group.
- At six weeks, the MDOT group showed significantly fewer incorrect MDI-S steps (0 vs 2.9) compared to the control group.
Conclusions:
- Mobile Direct Observed Therapy (MDOT) is a well-accepted and effective tool for improving inhaler technique in children with asthma.
- MDOT offers a feasible and beneficial approach to asthma care, enhancing patient outcomes.
- Caregiver engagement and adherence were high, supporting the use of digital health in pediatric asthma management.
Objective:
We aimed to assess the acceptability of Mobile Direct Observed Therapy (MDOT) amongst the parents/caregivers of children with asthma.
Methods:
This open-label pilot randomized controlled trial enrolled newly diagnosed children aged 5-15 years with asthma, who were followed up telephonically for six weeks. Parents of children in the intervention arm were requested to record a video of the metered dose inhaler with spacer (MDI-S) technique of their child on a mobile phone and share it through WhatsApp with investigator who then provided corrective measures as required by a text/video message. The children in the control arm continued follow-up telephonically without exchange of any videos for six weeks. The primary outcome measures were the acceptability of MDOT and the effect of such interaction on the correctness of the MDI-S technique. Secondary outcome measures were the level of asthma control as per GINA guidelines and the caregivers' perception and feedback about MDOT.
Results:
A total of 30 children were enrolled, 15 in each arm. Thirteen (86%) parents uploaded good-quality videos. The average number of incorrect steps decreased from 2.64 in the first video to 0.18 after the fourth video and nil after the fifth video in the MDOT group. At six weeks of follow-up, the average number of incorrect steps was significantly lower in the MDOT group compared to the control group (0 vs 2.9; P < 0.001). The proportion of children having controlled asthma was better in the MDOT group compared to controls (85% vs 70%) (P = 0.39). All parents liked MDOT.
Conclusion:
MDOT was well accepted by caregivers of children with asthma and was helpful in improving the MDI-S technique.
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