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Cited by 105Medication Adherence and ComplianceMobile Health and mHealth ApplicationsAsthma and respiratory diseases

Digital interventions to improve adherence to maintenance medication in asthma

Open access
Chan, Amy, De Simoni, Anna, Wileman, Vari, Holliday, Lois, Newby, Chris J, Chisari, Claudia, Ali, Sana, Zhu, Natalee +4 more·2022·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd013030.pub2PMC PMC9188849
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Abstract

BACKGROUND: Asthma is the most common chronic lung condition worldwide, affecting 334 million adults and children globally. Despite the availability of effective treatment, such as inhaled corticosteroids (ICS), adherence to maintenance medication remains suboptimal. Poor ICS adherence leads to increased asthma symptoms, exacerbations, hospitalisations, and healthcare utilisation. Importantly, suboptimal use of asthma medication is a key contributor to asthma deaths. The impact of digital interventions on adherence and asthma outcomes is unknown. OBJECTIVES: To determine the effectiveness of digital interventions for improving adherence to maintenance treatments in asthma. SEARCH METHODS: We identified trials from the Cochrane Airways Trials Register, which contains studies identified through multiple electronic searches and handsearches of other sources. We also searched trial registries and reference lists of primary studies. We conducted the most recent searches on 1 June 2020, with no restrictions on language of publication. A further search was run in October 2021, but studies were not fully incorporated. SELECTION CRITERIA: We included randomised controlled trials (RCTs) including cluster- and quasi-randomised trials of any duration in any setting, comparing a digital adherence intervention with a non-digital adherence intervention or usual care. We included adults and children with a clinical diagnosis of asthma, receiving maintenance treatment. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures for data collection. We used GRADE to assess quantitative outcomes where data were available. MAIN RESULTS: change is below 12%. Digital interventions likely increase quality of life (SMD 0.26 higher, 95% CI 0.07 to 0.45; moderate-certainty evidence); however, this is a small effect that may not be clinically significant. Acceptability data showed positive attitudes towards digital interventions. There were no data on cost-effectiveness or adverse events. Our confidence in the evidence was reduced by risk of bias and inconsistency. AUTHORS' CONCLUSIONS: Overall, digital interventions may result in a large increase in adherence (low-certainty evidence). There is moderate-certainty evidence that digital adherence interventions likely improve asthma control to a degree that is clinically significant, and likely increase quality of life, but there is little or no improvement in lung function. The review found low-certainty evidence that digital interventions may reduce asthma exacerbations. Subgroup analyses show that EMDs may improve adherence by 23% and SMS interventions by 12%, and interventions with an in-person element and adherence feedback may have greater benefits for asthma control and adherence, respectively. Future studies should include percentage adherence as a routine outcome measure to enable comparison between studies and meta-analysis, and use validated questionnaires to assess adherence and outcomes.

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3 of the 202 references couldn’t be matched to a known paper.

Research works printed but not linked: 14

  1. Federman A, O'Conor R, Mindlis I, Hauser D, Hoy-Rosas J, Lopez R, et al. A comprehensive self-management support program improves asthma control and quality of life among older adults: results of a randomized controlled trial. American Journal of Respiratory and Critical Care Medicine 2018;197:A2714.
  2. De Simoni A: dra the protocol; develop and run search strategy; obtain copies of studies; select which studies to include; extract data from studies; enter data into RevMan; carry out and interpret analysis; assessment of risk of bias in duplicate; review write-up.
  3. Wileman V: dra the protocol; develop and run search strategy; obtain copies of studies; select which studies to include; extract data from studies; enter data into RevMan; carry out and interpret analysis; assessment of risk of bias in duplicate; review write-up.
  4. Holliday L: dra the protocol; develop and run search strategy; obtain copies of studies; select which studies to include; extract data from studies; enter data into RevMan; carry out and interpret analysis; assessment of risk of bias in duplicate; review write-up.
  5. Newby C: dra the protocol; carry out and interpret analysis; statistical expertise and advice; review write-up.
  6. Chisari C: dra the protocol; develop and run search strategy; obtain copies of studies; select which studies to include; review write-up.
  7. Ali S: run search strategy; obtain copies of studies; select which studies to include; extract data from studies; enter data into RevMan; carry out and interpret analysis; assessment of risk of bias in duplicate; review write-up.
  8. Zhu N: run search strategy; obtain copies of studies; select which studies to include; extract data from studies; enter data into RevMan; carry out and interpret analysis; assessment of risk of bias in duplicate; review write-up.
  9. Padakanti P: run search strategy; obtain copies of studies; select which studies to include; extract data from studies; enter data into RevMan; carry out and interpret analysis; assessment of risk of bias in duplicate; review write-up.
  10. Pinprachanan V: run search strategy; obtain copies of studies; select which studies to include; extract data from studies; enter data into RevMan; carry out and interpret analysis; assessment of risk of bias in duplicate; review write-up.
  11. Ting V: run search strategy; obtain copies of studies; select which studies to include; extract data from studies; enter data into RevMan; carry out and interpret analysis; assessment of risk of bias in duplicate; review write-up.
  12. Griffiths C: review the protocol and final review write-up. Contributions of editorial team Sally Spencer (Co-ordinating Editor) edited the review; advised on methodology, interpretation and content; approved the review prior to publication.
  13. Rebecca Fortescue (Co-ordinating Editor): checked data entry in the review.
  14. Katy Pike (Contact Editor): edited the review; advised on methodology, interpretation, and content.

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Authors
Chan, A., De Simoni, A., Wileman, V., Holliday, L., Newby, C. J., Chisari, C., Ali, S., Zhu, N., Padakanti, P., Pinprachanan, V., Ting, V., & Griffiths, C. J.
Affiliations
  • University of Auckland (NZ)
  • Wolfson Institute of Population Health, Centre for Primary Care Asthma UK Centre for Applied Research; Barts and The London School of Medicine and Dentistry, Queen Mary University of London; London UK
  • UCL School of Pharmacy (GB)
  • Queen Mary University of London (GB)
  • University of Nottingham (GB)
  • Centre for Behavioural Medicine, Department of Practice and Policy, UCL School of Pharmacy; University College London; London UK
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2022-06-13
Volume
2022
Issue
6
Pages
CD013030-CD013030
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd013030.pub2
PMC
PMC9188849
OpenAlex
W4282571657
Cited by
105
References
202
Citations by year
2026: 12 · 2025: 30 · 2024: 32 · 2023: 24 · 2022: 4 · 2021: 2 · 2020: 1
FWCI
5.38
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Queen Mary Research Online (Queen Mary University of London) (submittedVersion)
  • ResearchSpace (University of Auckland) (submittedVersion)
Funders
  • Seoul National University Bundang Hospital
  • National Institute for Health and Care Research (ACF-2014-19-010)
  • Seoul National University
  • Agency for Healthcare Research and Quality
  • National Heart, Lung, and Blood Institute (R01HL073494)
  • NIH Clinical Center
Topics
  • Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
  • Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
Keywords
asthma, medication adherence, digital interventions, inhaled corticosteroids, maintenance therapy, SMS reminders, asthma exacerbations, asthma control, quality of life, lung function, cost-effectiveness, adverse events, risk of bias, subgroup analysis
MeSH terms
Adrenal Cortex Hormones, Adult, Asthma, Child, Forced Expiratory Volume, Humans, Quality of Life, Medication Adherence

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