Digital asthma self-monitoring influences inhaled corticosteroid adherence, SABA use

Self-monitoring using a digital platform and remote clinician feedback helped patients maintain adherence to inhaled corticosteroids and decreased short-acting beta agonist use, researchers reported.

“Poor adherence to inhaled corticosteroid-containing medications and overreliance on SABAs are well-known risk factors for uncontrolled asthma,” Giselle S. Mosnaim, MD, MS, clinical assistant professor in the division of pulmonary, allergy and critical care at NorthShore University Health System in Evanston, Illinois, and colleagues wrote in the Journal of Allergy and Clinical Immunology: In Practice. “However, patient self-report and clinician assessment often overestimate inhaled corticosteroid adherence, leading to costly treatment regimens that may not be appropriate. Rather than focusing on objectively assessing adherence and implementing strategies to promote medication-taking behavior, clinicians will often prescribe additional controller medications, oral corticosteroids or costly biologics.”

Researchers enrolled 100 adults with uncontrolled asthma (mean age, 48.5 years; 80% women) who were prescribed inhaled corticosteroids and SABAs. Participants’ inhalers were fitted with an electronic medication monitor (Propeller Health) to track use. After a 14-day baseline period, participants were randomly assigned to the treatment group (n = 75) or the control group (n = 25). The treatment group received reminders and feedback on their inhaled corticosteroid and SABA use using a smartphone app and clinician phone calls. The control group did not receive reminders or feedback.

At 14 weeks, the percentage of days free from SABA use was 77% in the treatment group vs. 81% in the control group. Days free of SABA use increased by 19% (95% CI, 12-26; P < .01) in the treatment group compared with 6% (95% CI, –3 to 16; P = .18) in the control group.

AT 14 weeks, adherence to daily inhaled corticosteroids was 68% in the treatment group vs. 51% in the control group. Adherence to inhaled corticosteroids changed minimally in the treatment group (–2%; 95% CI, –7 to 3; P = .4), but decreased significantly in the control group (–17%; 95% CI, –26 to –8; P < .01).

In addition, researchers observed that participants in the treatment group were more likely to have improved asthma control at 14 weeks (OR = 2.3; 95% CI, 0.7-7.7; P = .2), according to exploratory outcomes. Asthma exacerbations did not differ between the two groups (P = .8).

“To date, the implementation of these technologies has been fraught with obstacles. However, the accelerated uptake of telemedicine and demand or associated remote technologies and wearables to measure physiologic parameters may overcome these barriers,” the researchers wrote. “These technologies may also help clinicians to be more ethical stewards of costly biologic therapies, focusing on measuring and improving adherence to inhaled corticosteroids before prescribing a biologic.”