Electronic adherence monitoring identifies severe preschool wheezers who are steroid responsive

Abstract

Little is known about adherence to inhaled corticosteroids (ICS) in preschool children with troublesome wheeze. Children with aeroallergen senitization, or those reporting multiple trigger wheeze (MTW), are more likely to respond to ICS. We hypothesized that adherence to ICS and symptom control are only positively related in atopic children, or those reporting MTW. Patients aged 1 to 5 years with recurrent wheeze prescribed ICS were recruited from a tertiary respiratory clinic. Clinical phenotype and aeroallergen senitization were determined, and adherence assessed using an electronic monitoring device (Smartinhaler). Symptom control (test for respiratory and asthma control in kids [TRACK]), quality of life (PACQLQ), airway inflammation (offline exhaled nitric oxide) were assessed at baseline and follow‐up. Forty‐eight children (mean age 3.7 years; SD, 1.2) were monitored for a median of 112 (interquartile range [IQR], 91‐126) days. At baseline n = 29 reported episodic viral wheeze and n = 19 reported MTW. Twenty‐four out of 48 (50%) wheezers had suboptimal ICS adherence (<80%). Median adherence was 64% (IQR, 38‐84). There was a significant increase in TRACK and PACQLQ in the group as a whole, unrelated to adherence. In subgroup analysis only atopic wheezers with moderate or good adherence ≥ 60% had a significant increase in TRACK. There was no relationship between clinical phenotype, and adherence or TRACK. In this pilot study, overall adherence to ICS was suboptimal and was positively related to symptom control in atopic wheezers only. Assessments of adherence are important in preschool troublesome wheezers before therapy escalation to help identify those with an ICS responsive phenotype.

Advancing Digital Solutions to Overcome Longstanding Barriers in Asthma and COPD Management

“…3 , 4 However, van Boven et al reported that more than 80% of patients (98/120) commencing GINA step 5 therapies for severe asthma had poor adherence to ICS/long-acting beta agonist therapy over the previous 12 months. 61 In a study of preschool-age children with severe wheeze by Bingham et al, 62 50% (24/48) had suboptimal adherence with ICS, while Lee et al 63 reported that at least 50% of 69 patients with difficult asthma eligible for novel therapies, such as biologics and thermoplasty, were nonadherent with their ICS or ICS/long-acting beta agonist therapy medication. These studies highlight an unmet need for better identification of medication adherence in patients with respiratory disease.…”