Systematic Review of Electronic Monitoring to Increase Medication Adherence in Children With Asthma

While asthma can be well-controlled with the use of inhaled corticosteroids (ICS), most children do not adhere to treatment, leading to exacerbations, emergency department (ED) visits, hospitalizations, and deaths. Electronic monitoring devices (EMDs) have been shown to increase ICS adherence and improve asthma outcomes, but have not been well-studied in young people. The aim of this systematic review is to determine the feasibility and efficacy of EMDs in children with asthma.

This review was conducted according to PRISMA guidelines. PubMed and CINAHL were searched using keywords such as asthma, wearable electronic devices, and medication adherence. Search results were screened and appraised using Covidence software. Articles were included if they were in English, peer-reviewed, published since 2000, used EMDs for inhaled corticosteroid (ICS) treatment adherence, and included participants with asthma under age 21.

Fourteen studies met inclusion criteria, with durations ranging from 2 to 12 months. Recruitment rates varied from 28% to 100%, and retention rates ranged from 51% to 100%. Participants found EMDs acceptable in four of six and feasible in five of six studies, highlighting ease of use and perceived benefits. Six of the 12 studies measuring ICS adherence reported improvements using EMDs with feedback compared to monitoring alone. Seven out of nine studies found improvements in asthma control, and four out of seven found reduced ED visits and hospitalizations. These findings highlight the overall efficacy of EMDs.

EMDs can improve ICS adherence in children with asthma, especially with sustained feedback. However, inconsistent results highlight the need for comprehensive approaches addressing behavioral and systemic factors.