STAAR: a randomised controlled trial of electronic adherence monitoring with reminder alarms and feedback to improve clinical outcomes for children with asthma

Morton, Robert W.; Elphick, Heather; Rigby, Alan S.; Daw, William; King, David; Smith, Laurie; Everard, Mark L.

doi:10.1136/thoraxjnl-2015-208171

Cited by 143 publications

(164 citation statements)

References 36 publications

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“…Asthma conditions were improved by the diary intervention used in the present study, as it has been reported in the past (Britto et al, ; Morton et al, ). Our results indicate a reciprocal relationship between improved support for asthma management using a web‐based caregiver platform and improved disease control.…”

Section: Discussionsupporting

confidence: 72%

“…The asthma diary entry rate was exceptionally high (93.5% on average) in the present study. We also found that daily medication administration rates were relatively high relative to those of other reports (Bender et al, 2015;Otsuki et al, 2009) 6.2 | Improvements in asthma condition with diary use Asthma conditions were improved by the diary intervention used in the present study, as it has been reported in the past (Britto et al, 2017;Morton et al, 2017). Our results indicate a reciprocal relationship between improved support for asthma management using a web-based caregiver platform and improved disease control.…”

Section: Adherence Improvementssupporting

confidence: 70%

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Effects of maintaining web‐based diaries by caregivers on adherence to care regimens in preschoolers with asthma

Hashi

Tsukasaki

Nakamura

et al. 2019

Specialist Pediatric Nursing

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Background The objective of this pilot study was to assess the effects of maintaining web‐based diaries by the caregivers of preschoolers with asthma on the adherence to asthma care regimens, the recognition of asthma symptoms, and their perceived levels of parenting stress, quality of life, and family functioning. Design and Methods The caregivers of preschoolers with asthma completed a 4‐week web‐based diary and received weekly emails that depicted their children's asthma symptoms. We compared asthma symptoms from before and after the intervention. We analyzed demographic data, such as the caregivers’ age and education, and assessment scores from the Japanese Pediatric Asthma Control program (JPAC), Adherence with Asthma Management for Caregivers of Preschoolers (AAMCP), General Functioning subscale of the Family Assessment Device (GF‐FAD), Parenting Stress Index Short Form (PSI‐SF), and Quality of Life assessment scale for Caregivers of Asthmatic Children 24 (QOLCA‐24). Results A total of 45 participants were included in the analyses. The mean scores depicting asthma control were significantly improved postintervention (pre: 12.29 ± 2.65; post: 13.02 ± 2.01; t = −2.15, p = .037). Mean AAMCP scores postintervention (52.13 ± 6.25) were significantly greater than before (49.78 ± 7.20; t = −3.07; p = .004). Practice Implications Adherence to asthma care and the recognition of asthma symptoms improved following the use of a web‐based diary, making it a potential cost‐effective intervention for asthma patients and their families.

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Section: Discussionsupporting

confidence: 72%

Section: Adherence Improvementssupporting

confidence: 70%

Effects of maintaining web‐based diaries by caregivers on adherence to care regimens in preschoolers with asthma

Hashi

Tsukasaki

Nakamura

et al. 2019

Specialist Pediatric Nursing

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“…11 Careful review of an individual's pharmacy records to identify a low rate of prescription refills is particularly informative as patients overestimate their adherence. 12 A further major concern is the incorrect use of inhalers, which was recently shown in a systematic review to be as problematic now as it was twenty-five years ago.…”

Section: Summary Of Evidence and Key Messagesmentioning

confidence: 99%

Recognition and management of severe asthma: A Canadian Thoracic Society position statement

FitzGerald

Lemière

Lougheed

et al. 2017

Canadian Journal of Respiratory, Critical Care, and Sleep Medic

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RATIONALE: While severe asthma affects approximately 5% of all individuals with asthma, this small minority of individuals accounts for a large proportion of the asthma-related costs. Greater understanding of the pathophysiology of asthma combined with the emergence of novel biologic therapies for severe asthma supported the need for a thorough review of the diagnosis, investigation, phenotyping, and management of severe asthma. OBJECTIVES: We aimed to propose a practical approach to distinguish uncontrolled asthma due to inadequate asthma management from severe asthma despite optimal asthma management. Moreover, based on emerging scientific evidence, we sought to provide guidance for characterizing individuals with severe asthma and considering a phenotype-specific management. We also aimed to review other novel new potential therapeutic approaches. METHODS: We systematically reviewed the relevant literature focusing on randomized controlled trials and when available, systematic reviews of randomized controlled trials. The proposed key messages, based on scientific evidence and expert opinion, were agreed upon by unanimous consensus. MAIN RESULTS: We defined severe asthma and outlined its significant impact from the societal and patient perspectives. We outlined a practical approach to distinguish severe from uncontrolled but not severe asthma, based on stepwise investigation and management of potential reasons for uncontrolled asthma. After reviewing the current evidence we concluded that: 1) Several biomarkers (e.g. sputum or blood eosinophil count, total IgE, or FeNO) can help identify potential responders to new therapeutic options; 2) Tiotropium may be considered as an add-on therapy for individuals 12 years of age and over with severe asthma uncontrolled despite combination ICS/LABA therapy; 3) The chronic use of macrolides may decrease asthma exacerbations in individuals 18 years of age and over with severe asthma independent of their inflammatory profile; 4) Children aged 6 years and older and adults who are sensitized to at least one relevant perennial allergen and who remain poorly controlled asthmatics despite high dose ICS and a second controller can benefit from the addition of anti-IgE therapy to reduce asthma exacerbations; due to the known risk of side effects associated with high-dose ICS in children, omalizumab should also be considered in children and adolescents who repeatedly exacerbate or have poor control when therapy is stepped down from high-dose to moderate-dose ICS and at least one other controller; 5) Anti-IL5 therapies may be considered for adults 18 years of age and over with severe eosinophilic asthma who experience recurrent asthma exacerbations in spite of high doses of ICS in addition to at least one other controller; and 6) Although bronchial thermoplasty has shown a decrease in asthma exacerbations in one study, its role in the treatment of severe asthma remains uncertain. CONCLUSIONS: After reviewing existing and emerging therapies for severe asthma, we developed ke...

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“…Previous studies have demonstrated that the quality of asthma care provided by specially trained asthma nurses (nurse-led asthma care) was equal to that provided by physicians, with an additional advantage of reducing medical expenses (Kamps et al, 2004;Kuethe, Vaessen-Verberne, Elbers, & Van Aalderen, 2013). Studies also showed that appropriate asthma management measures to ensure patient treatment adherence could significantly improve clinical outcomes for children with asthma (Farzandipour, Nabovati, Sharif, Arani, & Anvari, 2017; Global Initiative for Asthma, 2017; Morton et al, 2017). Computer and internet applications are more frequently applied in health care these days and asthma management programs adopting technological interventions to encourage patient engagement could improve asthma management (Arnold, Stingone, & Claudio, 2012;Katwa & Rivera, 2018;Morita et al, 2019;Trivedi, 2015;Voorend-van Bergen et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

A randomized controlled trial of a mobile application‐assisted nurse‐led model used to improve treatment outcomes in children with asthma

Lv¹,

Wang³

et al. 2019

Journal of Advanced Nursing

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Aim To evaluate the effectiveness of a mobile application‐assisted nurse‐led management model in childhood asthma. Background Studies have shown that a nurse‐led asthma management model can improve asthma outcomes. However, the role of a mobile application‐assisted nurse‐led model in paediatric asthma management has not been studied well. Design A multi‐centre randomized clinical trial. Methods The trial was conducted between March 2017–March 2018. A total of 152 children (6 to 11.9 years old) were enrolled, with 77 children in the experimental group and 75 in the control group. All children received nurse‐led asthma management and other routine treatment measures, including inhaled corticosteroids. Meanwhile, a mobile application was used to manage asthma only for children in the experimental group. Primary outcome was frequency of asthma exacerbations. All outcomes were evaluated twice a month for 12 months. Results Compared with the pre‐enrollment period, frequency of asthma exacerbations decreased in the post‐enrollment period in the two groups, with a greater decrease in the experimental group. Compared with children in the control group, children in the experimental group had better secondary outcomes, such as improved adherence, higher Childhood Asthma Control Test scores, decreased respiratory tract infections, days of antibiotic use, days of school absence, parental work loss, and medical expenses. Conclusion A mobile application‐assisted nurse‐led management model decreased asthma exacerbations and improved secondary outcomes in children with asthma. Further research is needed to verify its validity in larger population samples. Impact Children with asthma benefited from a nurse‐led asthma management model when combined with mobile application. This trial suggested that computer and Internet technologies should be incorporated into nurse‐led asthma strategy in paediatric asthma management. Trial registration: The current trial was registered online with the Chinese Clinical Trial Registry (registration number: ChiCTR1800016726).

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STAAR: a randomised controlled trial of electronic adherence monitoring with reminder alarms and feedback to improve clinical outcomes for children with asthma

Cited by 143 publications

References 36 publications

Effects of maintaining web‐based diaries by caregivers on adherence to care regimens in preschoolers with asthma

Effects of maintaining web‐based diaries by caregivers on adherence to care regimens in preschoolers with asthma

Recognition and management of severe asthma: A Canadian Thoracic Society position statement

A randomized controlled trial of a mobile application‐assisted nurse‐led model used to improve treatment outcomes in children with asthma

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