Digital Technologies for Monitoring and Improving Treatment Adherence in Children and Adolescents With Asthma: Scoping Review of Randomized Controlled Trials

Abstract

Background Inadequate pediatric asthma care has resulted in potentially avoidable unplanned hospital admissions and morbidity. A wide variety of digital technologies have been developed to monitor and support treatment adherence in children and adolescents with asthma. However, existing reviews need to be updated and expanded to provide an overview of the current state of research on these technologies and how they are being integrated into existing health care services and care pathways. Objective This study aims to provide an overview of the current research landscape and knowledge gaps regarding the use of digital technologies to support the care of children and adolescents with asthma. Methods This study was structured according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) and Population, Intervention, Comparator, Outcome, and Study frameworks. Five databases (PubMed, the Cochrane Central Register of Controlled Trials, Web of Science, Embase, and PsycINFO) were systematically searched for studies published in English from 2014 onward. Two reviewers independently screened the references and selected studies for inclusion based on the eligibility criteria. Data were systematically extracted per research question, which were synthesized in a descriptive analysis. Results A wide variety of study characteristics, including the number and age of participants, study duration, and type of digital intervention, were identified. There was mixed evidence for the effectiveness of the interventions. Of the 10 studies that evaluated treatment adherence, 7 (70%) found improvements, but the evidence was inconsistent for asthma control (6/9, 67% of studies reported improvement or maintenance, but only 1 was significantly different between groups) and health outcome variables (5/9, 56% of studies found no evidence of effectiveness). The 6 studies that examined patient perceptions and assessments of acceptability and usability generally had positive findings. Conclusions A wide range of digital interventions are being developed and evaluated to support the monitoring and treatment adherence of children and adolescents with asthma. Meta-analyses are inhibited by the use of samples with a variety of overlapping age ranges; a theoretical framework for evaluating specific age groups would aid comparison between studies. Most studies found significant evidence for improved adherence to treatment or medications, but there was mixed evidence of the impact of the digital interventions on asthma control and other health outcomes. There are gaps in the literature relating to cost-effectiveness and integration with existing clinical care pathways. This study will be necessary to determine which digital interventions for children and young people with asthma are worth supporting and adopting in the clinical care pathways.

Severe Asthma, Telemedicine, and Self-Administered Therapy: Listening First to the Patient

“…During the COVID-19 pandemic, every effort was carried out to prevent a possible infection in patients affected by severe chronic respiratory diseases, such as severe asthma. Specific pathways have been identified to allow patients to receive appropriate medical care and to carry on the biological therapies, thus preventing the lack of disease control, as well as acute severe complications [3][4][5][6][7][8][9][10]. Thus far, to our current knowledge, no investigations have been carried out among the severe asthma patients to evaluate their perspectives about the telemedicine approach.…”

“…The COVID-19 pandemic has notably impacted health care resources, and the restrictions on in personvisits have in turn widely promoted the use of telemedicine for several chronic conditions, including bronchial asthma [3]. According to the results of previous studies, the telemedicine approach applied to the follow-up of asthmatic patients has been proven to be effective in reducing respiratory symptoms and improving quality of life [4,5]. Another study described a similar disease control in patients managed using telemedicine or by the conventional face-to-face visits, suggesting telemedicine is an effective tool for homemonitoring [6].…”

Severe Asthma, Telemedicine, Self-Administered Therapy: Listening First to the Patient

“…During the COVID-19 pandemic, every effort was carried out to prevent a possible infection in patients affected by severe chronic respiratory diseases such as severe asthma. Specific pathways have been identified to allow patients to receive appropriate medical care and to carry on the biological therapies, thus preventing the lack of disease control as well as acute severe exacerbations [3][4][5][6][7][8][9][10]. Up to now, as far as we know, no investigations have been carried out among the severe asthma patients to evaluate their perspective about the telemedicine approach.…”

“…The COVID -19 pandemic has impressively impacted on the health care resources, and the restrictions to in person-visits has widely promoted the use of telemedicine in several chronic conditions, including bronchial asthma [3]. According to the results of previous studies the telemedicine approach applied to the follow-up of asthmatic patients has been proved to be effective in reducing respiratory symptoms and improving their quality of life [4,5]. Another study described a similar disease control in patients managed by the use of telemedicine or by the conventional face-to-face visits suggesting telemedicine as an effective tool for home-monitoring [6].…”

Schweres Asthma, Telemedizin und selbst verabreichte Therapie: Zuerst auf den Patienten hören

“…Die COVID-19-Pandemie hat die Ressourcen des Gesundheitswesens erheblich beeinträchtigt, und die Beschränkungen für persönliche Kontrollen haben wiederum die Nutzung der Telemedizin für verschiedene chronische Erkrankungen, einschließlich Asthma bronchiale, stark gefördert [3]. Nach den Ergebnissen früherer Studien hat sich der telemedizinische Ansatz bei der Nachsorge von Asthmapatienten als wirksam erwiesen, um die Atemwegssymptome zu verringern und die Lebensqualität zu verbessern [4, 5]. Eine andere Studie beschrieb eine ähnliche Krankheitskontrolle bei Patienten, die mit Hilfe von Telemedizin oder durch herkömmliche persönliche Kontrollen behandelt wurden, was darauf hindeutet, dass die Telemedizin ein wirksames Instrument für die häusliche Kontrolle ist [6].…”