The impact of telemonitoring on adherence to nasal corticosteroid treatment in children with seasonal allergic rhinoconjunctivitis

Abstract

DISSERTATION Original AbstractThe impact of tele-monitoring on adherence to nasal corticosteroid treatment in children with seasonal allergic rhinoconjunctivitisBackground -Adherence to controller therapy in allergic diseases is low. Tele-monitoring has been proposed to improve adherence to treatment in chronic diseases. However, this strategy has never been tested in allergic rhinoconjunctivitis. Objective -To test whether Internet-based tele-monitoring during the grass pollen season of children with allergic rhinoconjunctivitis may enhance adherence to treatment. Methods -Children and adolescents, 5-18 years old, with moderate-to-severe seasonal allergic rhinoconjunctivitis to grass pollen requiring daily administration of nasal corticosteroid (mometasone) were recruited (April 2013) in a pediatric allergy practice. Participants were randomized to Internet-based monitoring (AllergyMonitor™, AM) or to usual care (no diary at all, controls) and followed from May 13th (T0) to June 15th 2013 (T2). An intermediate visit (T1) was performed between May 31st and June 2nd. Optimal adherence to therapy was expressed as the use of at least 0.190 g/day of mometasone, corresponding to one puff/nostril/day, and it was measured by canister weights during (T1) and at the end (T2) of the study period. Main secondary outcomes included the reported disease severity (validated self-questionnaire) and quality of life (AdoIRQLQ questionnaire), disease knowledge (multiple-choice questionnaire), nasal flow and resistance at baseline and at T2. Results -The use of mometasone, expressed as both optimal adherence rate (48.4% vs 12.5%; p=0.002) and average daily use (0.20+0.12 g/day vs 0.15+0.07 g/day; p=0.037), was higher in the AM group (n=31) than among controls (n=32). Disease knowledge improved among the patients using AM (83.3% vs 68.3%; p<0.001) but not among controls (68.2% vs 67.7% right answers; p>0.05). No differences were observed in the reported severity of disease, nasal flow and resistance and quality of life both at baseline and at follow-up visits. Conclusions -Internet-based tele-monitoring improves adherence to nasal corticosteroid treatment and disease knowledge among children and adolescents with seasonal allergic rhinoconjunctivitis.

Next-generation Allergic Rhinitis and Its Impact on Asthma (ARIA) guidelines for allergic rhinitis based on Grading of Recommendations Assessment, Development and Evaluation (GRADE) and real-world evidence

“…It adds novel information that was not available with other methods. [61][62][63][64][65][66][67] In addition, the mere number of observations that mobile technology can provide offers an unprecedented body of evidence that can complement conventional randomized controlled trials for RWE.…”

The role of mobile health technologies in allergy care: An EAACI position paper

“…Very few apps had been clinically validated and many were not based on guidelines or clinical evidence. Since then, various studies have evaluated the advantages, usability, efficiency, and risks of mobile health technologies in allergic rhinitis, asthma, atopic dermatitis, food allergy, and anaphylaxis …”

“…These results prompted ARIA to develop a self‐management strategy rather than targeting an increase in adherence. Nevertheless, Internet‐based telemonitoring improves the taking of intranasal corticosteroid (INCS) and improves disease knowledge among children and adolescents with seasonal allergic rhinoconjunctivitis . Push notifications offer a promising strategy for enhancing engagement with smartphone‐based health interventions in allergic rhinitis.…”

Mobile health tools for the management of chronic respiratory diseases

“…A trial in asthma patients demonstrated that reminders in the form of text messages and automated phone calls increased patient treatment adherence . In AR patients, internet‐based tele‐monitoring improved adherence to nasal corticosteroids treatment . These studies show that there is an opportunity for improving treatment adherence and clinical outcomes by integrating reminders into apps …”