e-Monitoring of Asthma Therapy to Improve Compliance in children using a real-time medication monitoring system (RTMM): the e-MATIC study protocol

Abstract

BackgroundMany children with asthma do not have sufficient asthma control, which leads to increased healthcare costs and productivity loss of parents. One of the causative factors are adherence problems. Effective interventions improving medication adherence may therefore improve asthma control and reduce costs. A promising solution is sending real time text-messages via the mobile phone network, when a medicine is about to be forgotten. As the effect of real time text-messages in children with asthma is unknown, the primary aim of this study is to determine the effect of a Real Time Medication Monitoring system (RTMM) with text-messages on adherence to inhaled corticosteroids (ICS). The secondary objective is to study the effects of RTMM on asthma control, quality of life and cost-effectiveness of treatment.MethodsA multicenter, randomized controlled trial involving 220 children (4–11 years) using ICS for asthma. All children receive an RTMM-device for one year, which registers time and date of ICS doses. Children in the intervention group also receive tailored text-messages, sent only when a dose is at risk of omission. Primary outcome measure is the proportion of ICS dosages taken within the individually predefined time-interval. Secondary outcome measures include asthma control (monthly Asthma Control Tests), asthma exacerbations, healthcare use (collected from hospital records, patient reports and pharmacy record data), and disease-specific quality of life (PAQLQ questionnaire). Parental and children’s acceptance of RTMM is evaluated with online focus groups and patient questionnaires. An economic evaluation is performed adopting a societal perspective, including relevant healthcare costs and parental productivity loss. Furthermore, a decision-analytic model is developed in which different levels of adherence are associated with clinical and financial outcomes. Also, sensitivity analyses are carried out on different price levels for RTMM.DiscussionIf RTMM with tailored text-message reminders proves to be effective, this technique can be used in daily practice, which would support children with suboptimal adherence in their asthma (self)management and in achieving better asthma control and better quality of life.Trial registrationNetherlands Trial Register NTR2583.

Metered dose inhaler-spacer use education effects on achieve asthma control in children

“…Correlation of ACQ with functional parameters related to asthma in children has also been demonstrated in six minute walking test in a previous study (35). Some authors reported that patients who use their inhalation device correctly have better asthma control (3,5,8,11,36). McWhirter et al, Horner and Brown showed that children with asthma have lower requirement for medication, reduction in symptoms of wheeze and improvement in children's quality of life as their inhaler skill improved (14,15).…”

“…However influence of this modality on asthma control on long term has only achieved in a few number of previous studies in children (3,14,15). Therefore, the aim of this study was to evaluate the change in asthma control and after standardized education on proper MDI-Spacer use.…”

“…Global initiative for asthma (GINA) indicates that inhaled steroids are the mainstay of asthma treatment in children (2). However effective asthma management can only be done with good self management and optimal use of asthma medications via inhaler device (3,4). In 2011, GINA is focused on patient education about asthma (2).…”

“…Inhaled treatment has many advantages such as direct fast onset of action due to local delivery high concentration of the drug to the airways with minimal systematic side effects however, use of these medications with improper technique leads to the inefficacy of treatment (5)(6)(7)(8). Inefficient inhaler treatment results in poor asthma outcomes, frequent exacerbations, increased hospitalization rates and medication cost (3,5,(8)(9)(10)(11).…”

“…Influence of standardized education of patients on improvement of inhalation technique has been demonstrated (3,4,7,9,10). However influence of this modality on asthma control on long term has only achieved in a few number of previous studies in children (3,14,15).…”