Abstract
Background: Poor adherence to inhaled corticosteroids (ICS) is a risk factor for asthma exacerbations in children. Reminding systems are a promising tool for improving adherence, but have not been tested in children with asthma.
Aims and objectives: Main aim is to study the effect of Real Time Medication Monitoring (RTMM) with SMS reminders on adherence to ICS. Secondary aim is to study the effects on asthma control (AC), asthma-specific quality of life (QoL) and the frequency of exacerbations. Final aim was to study whether the intervention is cost-effective.
Methods: In a multicenter, randomized controlled trial in children (4-11 years) using ICS for asthma, all children received an RTMM-device for 12 months. The intervention group also received tailored SMS reminders, sent only when a dose was at risk of omission. Outcome measures: adherence to ICS (RTMM data), AC (c-ACT questionnaire), QoL (PAQLQ questionnaire) and asthma exacerbations. Costs were calculated from a healthcare and from a societal perspective.
Results: 209 children were included. Mean adherence was 69.0% in the intervention group and 57.3% in the control group (difference 11.8%; 95%CI 6.9%-17.5%). The difference gradually declined from 15.2% in the first 6 months, but remained stable at 8.3% over the last 6 months. No differences were found for AC (mean ACT score 21.1 vs 22.2), QoL (mean PAQLQ score 6.2 vs 6.3) or asthma exacerbations (yearly rate 0.23 vs 0.37). Costs were higher in the intervention group: €719 versus €615 from the healthcare perspective and €1030 versus €743 from a societal perspective.
Conclusions: RTMM with tailored SMS reminders effectively improves adherence to ICS, but not AC, QoL or exacerbations in this population.
- Copyright ©ERS 2015