Use of digital measurement of medication adherence and lung function to guide the management of uncontrolled asthma (INCA Sun): a multicentre, single-blinded, randomised clinical trial

Hale, Elaine Mac; Greene, Garrett; Mulvey, Christopher; Mokoka, Matshediso; Boven, Job F.M. van; Cushen, Breda; Brennan, Victoria; Kerr, Patrick; Reilly, Richard B.; Hughes, Cian; Kent, Brian D.; Jackson, David J.; Butler, Marcus O.; Counihan, Ian; Hayes, James C.; Faul, John L.; Convery, Rory; Kelly, Alexandra M Nanzer; FitzGerald, J. Mark; Murphy, Desmond M.; Heaney, Liam G.; Costello, Richard W.; Lombard, Lorna; Walsh, Joanne; Plunkett, Sinead; McCartan, Thomas

doi:10.1016/s2213-2600(22)00534-3

Cited by 28 publications

(4 citation statements)

References 32 publications

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“…The Global Asthma Initiative Guideline (GINA) ( Global Initiative for Asthma, 2023 ) has continued to incorporate changes due to the collection of new evidence related to the efficacy and safety of ICS, LABA, and short-acting beta-agonists (SABAs). More recent longitudinal studies ( Azzi et al, 2017 ; Johnson et al, 2017 ; Souverein et al, 2017 ; Papi et al, 2018 ; Dima et al, 2019 ; Vervloet et al, 2020 ; Vervloet et al, 2022 ; Hale et al, 2023 ; Sousa-Pinto et al, 2023 ) have presented further evidence of the long-term role of ICS adherence in asthma. However, none were conducted specifically on a pediatric population, only one included HRQoL ( Hale et al, 2023 ), few specified the adherence stage considered ( Souverein et al, 2017 ; Dima et al, 2019 ; Vervloet et al, 2020 ; Vervloet et al, 2022 ), and only one included medication adherence alongside the inhalation technique ( Hale et al, 2023 ).…”

Section: Introductionmentioning

confidence: 94%

“…More recent longitudinal studies ( Azzi et al, 2017 ; Johnson et al, 2017 ; Souverein et al, 2017 ; Papi et al, 2018 ; Dima et al, 2019 ; Vervloet et al, 2020 ; Vervloet et al, 2022 ; Hale et al, 2023 ; Sousa-Pinto et al, 2023 ) have presented further evidence of the long-term role of ICS adherence in asthma. However, none were conducted specifically on a pediatric population, only one included HRQoL ( Hale et al, 2023 ), few specified the adherence stage considered ( Souverein et al, 2017 ; Dima et al, 2019 ; Vervloet et al, 2020 ; Vervloet et al, 2022 ), and only one included medication adherence alongside the inhalation technique ( Hale et al, 2023 ). These last two concepts are closely related, with the poor inhalation technique even being considered an unintentional form of adherence ( van Boven et al, 2015 ), but they are usually identified as independent concepts ( Monteiro et al, 2022 ).…”

Section: Introductionmentioning

confidence: 94%

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Impact of treatment adherence and inhalation technique on asthma outcomes of pediatric patients: a longitudinal study

Lizano-Barrantes,

Garin,

Mayoral

et al. 2024

Front. Pharmacol.

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Introduction: We aimed to evaluate the longitudinal relationships, both at between- and within-person levels, that adherence to inhaled corticosteroid-based maintenance treatment and inhalation technique present with symptom control, exacerbations, and health-related quality of life (HRQoL) in children and adolescents with asthma.Methods: Participants (6–14 years old) from the ARCA (Asthma Research in Children and Adolescents) cohort—a prospective, multicenter, observational study (NCT04480242)—were followed for a period from 6 months to 5 years via computer-assisted telephone interviews and a smartphone application. The Medication Intake Survey–Asthma (MIS-A) was administered to assess the implementation stage of adherence, and the Inhalation Technique Questionnaire (InTeQ) was used to assess the five key steps when using an inhaler. Symptom control was measured with the Asthma Control Questionnaire (ACQ), and HRQL was measured with the EQ-5D and the Patient-Reported Outcomes Measurement Information System–Pediatric Asthma Impact Scale (PROMIS-PAIS). Multilevel longitudinal mixed models were constructed separately with symptom control, exacerbation occurrence, EQ-5D, and PROMIS-PAIS as the dependent variables.Results: Of the 360 participants enrolled, 303 (1,203 interviews) were included in the symptom control and exacerbation analyses, 265 (732) in the EQ-5D, and 215 (617) in the PROMIS-PAIS. Around 60% of participants were male subjects, and most of them underwent maintenance treatment with inhaled corticosteroids plus long-acting β-agonists in a fixed dose (73.3%). Within-person variability was 83.6% for asthma control, 98.6% for exacerbations, 36.4% for EQ-5D, and 49.1% for PROMIS-PAIS. At the within-person level, patients with higher adherence had better symptom control (p = 0.002) and HRQoL over time (p = 0.016). Patients with a better inhalation technique reported worse HRQoL simultaneously (p = 0.012), but they showed better HRQoL in future assessments (p = 0.012). The frequency of reliever use was associated with symptom control (p < 0.001), exacerbation occurrence (p < 0.001), and HRQoL (p = 0.042); and boys were more likely to present better symptom control and HRQoL than girls.Conclusion: Our results confirm longitudinal associations at the within-person level of the two indicators of quality use of inhalers: for adherence to maintenance treatment with symptom control and HRQoL, and for the inhalation technique with HRQoL. Although treatment adherence was shown to be excellent, a third of the participants reported a suboptimal inhalation technique, highlighting the need for actions for improving asthma management of the pediatric population.

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Section: Introductionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 94%

Impact of treatment adherence and inhalation technique on asthma outcomes of pediatric patients: a longitudinal study

Lizano-Barrantes,

Garin,

Mayoral

et al. 2024

Front. Pharmacol.

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“…2 ). A respiratory example is smart inhalers that can remotely monitor medication adherence and inhaler technique [ 67 , 83 , 84 ▪ ]. These are ‘drug–device combinations’ as they contain a medical device, a software application as well as an active pharmaceutical ingredient so that both MDR and the European Medicines Agency (EMA) are relevant in regulatory assessment.…”

Section: Challenges Of the Policy Regulatory And Financial Contextmentioning

confidence: 99%

Implementation of digital home monitoring and management of respiratory disease

Pinnock

Hui

Boven

2023

Current Opinion in Pulmonary Medicine

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Purpose of reviewDigital respiratory monitoring interventions (e.g. smart inhalers and digital spirometers) can improve clinical outcomes and/or organizational efficiency, and the focus is shifting to sustainable implementation as an approach to delivering respiratory care. This review considers key aspects of the technology infrastructure, discusses the regulatory, financial and policy context that influence implementation, and highlights the overarching societal themes of equity, trust and communication. Recent findingsTechnological requirements include developing interoperable and connected systems; establishing stable, wide internet coverage; addressing data accuracy and monitoring adherence; realising the potential of artificial intelligence; and avoiding clinician data overload. Policy challenges include concerns about quality assurance and increasingly complex regulatory systems. Financial barriers include lack of clarity over cost-effectiveness, budget impact and reimbursement. Societal concerns focus on the potential to increase inequities because of poor e-health literacy, deprivation or lack of available infrastructure, the need to understand the implications for patient/professional interactions of shifting care to remote delivery and ensuring confidentiality of personal data.

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“…приверженность составила 64,9% в активной группе и 55,5% в контрольной группе (p = 0,0012). Авторы сделали заключение, что применение флутиказона/салметерола под контролем цифровых технологий привело к небольшому улучшению приверженности лечению и значительному снижению нагрузки на лечение [33].…”

Section: Chronic Pulmonary Diseasesunclassified

Combined therapy of broncho-obstructive pathology: two solutions to one problem

Vizel,

Vizel

2023

Medicinskij sovet

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Chronic broncho-obstructive pulmonary diseases – bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD) – are a serious clinical problem and an economic burden for practical healthcare. The purpose of the scientific review is to track the evolution of views on the use of bronchodilators and inhaled corticosteroids (ICS) in these diseases and to analyze modern approaches to treatment based on domestic and international guidelines. COPD treatment is aimed at two pathogenetic components – inflammation of the bronchi and the formation of emphysema. The basis of basic therapy remains the use of long-acting bronchodilators of two classes. Treatment of asthma is directed primarily at chronic inflammation of the airways using long-acting bronchodilators. The basis of basic therapy for asthma is the use of inhaled glucocorticosteroids. Currently, the same combinations of bronchodilators and ICS are recommended for both asthma and COPD. One direction is based on the use of ICS with formoterol, a 12-hour drug with a fast onset, in which the drug can be used on demand. The second direction is based on the constant use of ICS/LABA only on a regular basis, but with the ability to use bronchodilators on demand. In this case, ICS with high affinity are more often used. An important component of treatment is adherence to medical prescriptions and the availability of different types of drugs for patients in real clinical practice. At present, conditions have been created in Russia for the implementation of both the treatment of patients with asthma and the treatment of patients with COPD with frequent exacerbations and eosinophilia based on import substitution with modern drugs.

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Use of digital measurement of medication adherence and lung function to guide the management of uncontrolled asthma (INCA Sun): a multicentre, single-blinded, randomised clinical trial

Cited by 28 publications

References 32 publications

Impact of treatment adherence and inhalation technique on asthma outcomes of pediatric patients: a longitudinal study

Impact of treatment adherence and inhalation technique on asthma outcomes of pediatric patients: a longitudinal study

Implementation of digital home monitoring and management of respiratory disease

Combined therapy of broncho-obstructive pathology: two solutions to one problem

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