Cited by 265Medication Adherence and ComplianceAsthma and respiratory diseasesMobile Health and mHealth Applications

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The effect of an electronic monitoring device with audiovisual reminder function on adherence to inhaled corticosteroids and school attendance in children with asthma: a randomised controlled trial

Chan, Amy H Y, Stewart, Alistair W, Harrison, Jeff, Camargo, Carlos A, Black, Peter N, Mitchell, Edwin A·2015·The Lancet Respiratory Medicine

DOI 10.1016/s2213-2600(15)00008-9

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Abstract

Background Suboptimum adherence to preventive asthma treatment is associated with substantial morbidity and mortality, yet adherence often remains poor. We aimed to investigate whether use of an inhaler with audiovisual reminders leads to improved adherence and asthma outcomes in school-aged children who presented to the emergency department with an asthma exacerbation.Methods We did a randomised controlled trial in patients aged 6-15 years who attended the regional emergency department in Auckland, New Zealand with an asthma exacerbation and were on regular inhaled corticosteroids. Using a simple, unrestricted block randomisation with block sizes of 200, we randomly assigned patients to receive an electronic monitoring device for use with their preventer inhaler with the audiovisual reminder functions either enabled to support adherence to inhaled corticosteroids (intervention group) or disabled (control group). Participants were followed up every 2 months for 6 months. The primary outcomes were adherence to preventive inhaled corticosteroids and number of days absent from school for any reason. Asthma control was assessed as a secondary outcome. All analyses were done in the intention-to-treat population. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12613001353785.Findings The study took place between May 10, 2010, and Feb 26, 2012. We randomly assigned 220 patients, 110 to the intervention group and 110 to the control group. Median percentage adherence was 84% (10th percentile 54%, 90th percentile 96%) in the intervention group, compared with 30% (8%, 68%) in the control group (p<0·0001). The proportion of days absent from school for any reason was 1·9% (10th percentile 0·0%, 90th percentile 7·9%) in the intervention group and 1·7% (0·0%, 8·6%) in the control group. The change in asthma morbidity score from baseline to 6 months was significantly greater in the intervention group than in the control group (p=0·008), with a reduction of 2·0 points from a mean baseline score of 9·3 (SD 2·2) to 7·3 (2·1) in the intervention group, compared with a reduction of 1·2 points from a baseline of 9·2 (2·5) to 8·0 (2·2) in the control group.Interpretation Use of an electronic monitoring device with an audiovisual reminder led to significant improvements in adherence to inhaled corticosteroids in school-aged children with asthma. This intervention could be beneficial for the improvement of asthma control in patients for whom poor asthma control is related to poor adherence.Funding Health Research Council of New Zealand and Cure Kids.

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Chan, A. H. Y., Foot, H., Pearce, C. J., Horne, R., Foster, J. M., & Harrison, J. (2022) · PLOS ONE · doi:10.1371/journal.pone.0265715 · Cited by 47
Self-citation
Trajectory Analyses of Adherence Patterns in a Real-Life Moderate to Severe Asthma Population
van Boven, J. F. M., Koponen, M., Lalic, S., George, J., Bell, J. S., Hew, M. J., & Ilomäki, J. (2019) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2019.12.002 · Cited by 47
Novel electronic adherence monitoring devices in children with asthma: a mixed-methods study
Makhecha, S., Chan, A. H. Y., Pearce, C. J., Jamalzadeh, A., & Fleming, L. (2020) · BMJ Open Respiratory Research · doi:10.1136/bmjresp-2020-000589 · Cited by 46
Electronic monitoring with a digital smart spacer to support personalized inhaler use education in patients with asthma: The randomized controlled OUTERSPACE trial
Dierick, B. J. H., Achterbosch, M., Eikholt, A. A., Been-Buck, S., Klemmeier, T., van de Hei, S. J., Hagedoorn, P., Kerstjens, H. A. M., Kocks, J. W. H., & van Boven, J. F. M. (2023) · Respiratory Medicine · doi:10.1016/j.rmed.2023.107376 · Cited by 44
Anticipated barriers and facilitators for implementing smart inhalers in asthma medication adherence management
van de Hei, S. J., Stoker, N., Blok, B. M. J. F.-D., Poot, C. C., Meijer, E., Postma, M. J., Chavannes, N. H., Kocks, J. W. H., & van Boven, J. F. M. (2023) · npj Primary Care Respiratory Medicine · doi:10.1038/s41533-023-00343-w · Cited by 46
Factors associated with medication adherence in school-aged children with asthma
Chan, A. H. Y., Stewart, A. W., Foster, J. M., Mitchell, E. A., Camargo, C. A., & Harrison, J. (2016) · ERJ Open Research · doi:10.1183/23120541.00087-2015 · Cited by 43
Long-Term Cost-Effectiveness of Digital Inhaler Adherence Technologies in Difficult-to-Treat Asthma
van de Hei, S. J., Kim, C., Honkoop, P., Sont, J. K., Schermer, T. R., MacHale, E., Costello, R. W., Kocks, J. W. H., Postma, M. J., & van Boven, J. F. M. (2023) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2023.06.051 · Cited by 42
See I told you I was taking it! – Attitudes of adolescents with asthma towards a device monitoring their inhaler use: Implications for future design
Howard, S., Lang, A. R., Sharples, S., & Shaw, D. E. (2016) · Applied Ergonomics · doi:10.1016/j.apergo.2016.06.018 · Cited by 41
Novel methods for device and adherence monitoring in asthma
Bonini, M., & Usmani, O. S. (2017) · Current Opinion in Pulmonary Medicine · doi:10.1097/mcp.0000000000000439 · Cited by 41
Identifying Critical Errors: Addressing Inhaler Technique in the Context of Asthma Management
Bosnic-Anticevich, S. Z., Cvetkovski, B., Azzi, E., Srour, P., Tan, R. H., & Kritikos, V. S. (2018) · Pulmonary Therapy · doi:10.1007/s41030-018-0051-0 · Cited by 41
Does a tailored intervention to promote adherence in patients with chronic lung disease affect exacerbations? A randomized controlled trial
Gregoriano, C., Dieterle, T., Breitenstein, A.-L., Dürr, S., Baum, A., Giezendanner, S., Maier, S., Leuppi-Taegtmeyer, A. B., Arnet, I., Hersberger, K. E., et al. (2019) · Respiratory Research · doi:10.1186/s12931-019-1219-3 · Cited by 41
Patient-perceived acceptability and behaviour change benefits of inhaler reminders and adherence feedback: A qualitative study
Foster, J. M., Reddel, H. K., Usherwood, T. P., Sawyer, S. M., & Smith, L. D. (2017) · Respiratory Medicine · doi:10.1016/j.rmed.2017.05.013 · Cited by 41
Systematic Assessment of Difficult-to-Treat Asthma: Principles and Perspectives
Hew, M. J., Menzies-Gow, A. N., Hull, J. H., Fleming, L., Porsbjerg, C. M., Brinke, A. T., Allen, D. J., Gore, R. B., & Tay, T. R. (2020) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2020.02.036 · Cited by 40
The Effect of Connected “Smart” Inhalers on Medication Adherence
Zabczyk, C., & Blakey, J. (2021) · Frontiers in Medical Technology · doi:10.3389/fmedt.2021.657321 · Cited by 39
The Seven Stages of Man: The Role of Developmental Stage on Medication Adherence in Respiratory Diseases
Costello, R. W., Foster, J. M., Grigg, J., Eakin, M. N., Canonica, G. W., Yunus, F., & Ryan, D. P. (2016) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2016.04.002 · Cited by 39
What is New in the Management of Childhood Asthma?
Gupta, A. K., Bhat, G., & Pianosi, P. T. (2018) · The Indian Journal of Pediatrics · doi:10.1007/s12098-018-2705-1 · Cited by 39
Assessing adherence to inhaled therapies in asthma and the emergence of electronic monitoring devices
Dhruve, H., & Jackson, D. J. (2022) · European Respiratory Review · doi:10.1183/16000617.0271-2021 · Cited by 41
Electronic adherence monitoring device performance and patient acceptability: a randomized control trial
Chan, A. H. Y., Stewart, A. W., Harrison, J., Black, P., Mitchell, E. A., & Foster, J. M. (2017) · Expert Review of Medical Devices · doi:10.1080/17434440.2017.1322505 · Cited by 38
Longitudinal Patterns of Mexican and Puerto Rican Children’s Asthma Controller Medication Adherence and Acute Healthcare Use
Arcoleo, K. J., McGovern, C. M., Kaur, K., Halterman, J. S., Mammen, J. R., Crean, H. F., Rastogi, D., & Feldman, J. M. (2019) · Annals of the American Thoracic Society · doi:10.1513/annalsats.201807-462oc · Cited by 36
A pilot randomized trial of school-based administration of inhaled corticosteroids for at-risk children with asthma
Harrington, C. B., Langhans, E., Shelef, D. Q., Savitz, M., Whitmore, C., & Teach, S. J. (2017) · Journal of Asthma · doi:10.1080/02770903.2017.1323915 · Cited by 35
“Use of electronicmonitoring devices would have potentially improved our measurements of adherence [23].”
Background
User Acceptability and Technical Robustness Evaluation of a Novel Smart Pill Bottle Prototype Designed to Support Medication Adherence
Zijp, T. R., Touw, D. J., & van Boven, J. F. M. (2020) · Patient Preference and Adherence · doi:10.2147/ppa.s240443 · Cited by 35
Use of a Remote Inhaler Monitoring Device to Measure Change in Inhaler Use with Chronic Obstructive Pulmonary Disease Exacerbations
Sumino, K., Locke, E. R., Magzamen, S. L., Gylys-Colwell, I., Humblet, O., Nguyen, H. Q., Thomas, R. M., & Fan, V. S. (2017) · Journal of Aerosol Medicine and Pulmonary Drug Delivery · doi:10.1089/jamp.2017.1383 · Cited by 34
“The SmartTouch inhaler sensor improved the adherence to inhaled steroids in adults and adolescents with asthma,((4,13)) and more recently, the use of the reminder function of the inhaler sensor was shown to improve adherence and reduce asthma morbidity in children who visited the ED for asthma exacerbations.((5)) Anot…”
eHealth Technologies for Monitoring Pediatric Asthma at Home: Scoping Review
van der Kamp, M. R., Hengeveld, V., Brusse-Keizer, M. G. J., Thio, B., & Tabak, M. (2023) · Journal of Medical Internet Research · doi:10.2196/45896 · Cited by 34
“Some studies used automatic reminders (text message feedback [206], audiovisual reminders in the device [204], and app-based reminders [207]), whereas other studies had nurses [205,208] or pharmacists [78,200,209] providing feedback.”
Integrating digital inhalers into clinical care of patients with asthma and chronic obstructive pulmonary disease
Pleasants, R. A., Chan, A. H. Y., Mosnaim, G. S., Costello, R. W., Dhand, R., Schworer, S. A., Merchant, R. K., & Tilley, S. L. (2022) · Respiratory Medicine · doi:10.1016/j.rmed.2022.107038 · Cited by 33
Electronic adherence monitoring devices for children with asthma: A systematic review and meta-analysis of randomised controlled trials
Lee, J. R., Leo, S., Liao, S., Ng, W. R., Tay, T. Y. N., Wang, Y., Ang, W. H. D., & Lau, Y. (2021) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2021.104037 · Cited by 35
Electronic inhaler monitoring and healthcare utilization in chronic obstructive pulmonary disease
Alshabani, K., Attaway, A. H., Smith, M. J., Majumdar, U., Rice, R., Han, X., Wang, X., & Hatipoglu, U. S. (2019) · Journal of Telemedicine and Telecare · doi:10.1177/1357633x19850404 · Cited by 31
Current technological advancement in asthma care
Hakizimana, A., Devani, P., & Gaillard, E. A. (2024) · Expert Review of Respiratory Medicine · doi:10.1080/17476348.2024.2380067 · Cited by 30
“Similarly, Chan et al. [106] reported that the use of an electronic monitoring device with an in-built audio-visual reminder, significantly improved adherence in school-aged children with asthma.”
What are the pros and cons of electronically monitoring inhaler use in asthma? A multistakeholder perspective
Howard, S., Lang, A. R., Sharples, S., & Shaw, D. E. (2016) · BMJ Open Respiratory Research · doi:10.1136/bmjresp-2016-000159 · Cited by 29
A pilot investigation of a mobile phone application and progressive reminder system to improve adherence to daily prevention treatment in adolescents and young adults with migraine
Ramsey, R. R., Holbein, C. E., Powers, S. W., Hershey, A. D., Kabbouche, M. A., O’Brien, H. L., Kacperski, J. E., Shepard, J., & Hommel, K. A. (2018) · Cephalalgia · doi:10.1177/0333102418756864 · Cited by 29
Smartphones for Real-time Assessment of Adherence Behavior and Symptom Exacerbation for High-Risk Youth with Asthma: Pilot Study
Teufel, R. J., Patel, S. K., Shuler, A. B., Andrews, A. L., Nichols, M. G., Ebeling, M. D., Dawley, E. H., Mueller, M., Ruggiero, K. J., & Treiber, F. A. (2018) · JMIR Pediatrics and Parenting · doi:10.2196/pediatrics.9796 · Cited by 29
“Adherence to the controller medication (inhaled corticosteroids) regimen was calculated daily in 12-hour increments (12:00 am to 11:59 am and 12:00 pm to 11:59 pm) as the number of doses prescribed compared with the number taken over 12 hours to avoid the impact of medication overdosing and dumping [26,27].”
Personalizing medicine - could the smart inhaler revolutionize treatment for COPD and asthma patients?
Greene, G., & Costello, R. W. (2019) · Expert Opinion on Drug Delivery · doi:10.1080/17425247.2019.1628017 · Cited by 29
“The term smart inhaler covers a range of technology from simple tracking devices which record when an inhaler was used [4–6], to those which remind patients to take their inhaler [7,8], offer feedback on technique and timing, or record the interaction of environment and individual that prompts inhaler use.”
Background
Optimizing Patient Management and Adherence for Children Receiving Growth Hormone
Acerini, C. L., Wac, K., Bang, P., & Lehwalder, D. (2017) · Frontiers in Endocrinology · doi:10.3389/fendo.2017.00313 · Cited by 28
“For asthma management in children, an inhaler with audiovisual reminders and electronic monitoring increased corticosteroid adherence to 84% compared with 30% in a control group, and was associated with improved asthma morbidity score (26).”
Background
Integrated Adherence Monitoring for Inhaler Medications
Hew, M. J., & Reddel, H. K. (2019) · JAMA · doi:10.1001/jama.2019.1289 · Cited by 28
Technology Interventions for Nonadherence: New Approaches to an Old Problem
Bender, B. G. (2017) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2017.10.029 · Cited by 28
Can electronic monitoring with a digital smart spacer support personalised medication adherence and inhaler technique education in patients with asthma?: Protocol of the randomised controlled OUTERSPACE trial
Dierick, B. J. H., Achterbosch, M., Been-Buck, S., Klemmeier, T., van de Hei, S. J., Hagedoorn, P., Kerstjens, H. A. M., Kocks, J. W. H., & van Boven, J. F. M. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-059929 · Cited by 26
Applying Human-Centered Design to the Development of an Asthma Essentials Kit for School-Aged Children and Their Parents
Sonney, J., Duffy, M., Hoogerheyde, L. X., Langhauser, E., & Teska, D. (2018) · Journal of Pediatric Health Care · doi:10.1016/j.pedhc.2018.07.008 · Cited by 27
Electronic Adherence Monitoring in a High-Utilizing Pediatric Asthma Cohort: A Feasibility Study
Kenyon, C. C., Chang, J. C. H., Wynter, S.-A., Fowler, J., Long, J., & Bryant-Stephens, T. C. (2016) · JMIR Research Protocols · doi:10.2196/resprot.5362 · Cited by 26
Adherence to treatment in allergic respiratory diseases
Baiardini, I., Novakova, S. M., Mihaicuta, S. D., Oğuzülgen, İ. K., & Canonica, G. W. (2018) · Expert Review of Respiratory Medicine · doi:10.1080/17476348.2019.1554438 · Cited by 26
“Randomized controlled trials have shown that EMD with an audiovisual reminder led to significant improvements in adherence to ICS in school-aged children with asthma [90].”
Background
Connected drug delivery devices to complement drug treatments: potential to facilitate disease management in home setting
Bittner, B., Chiesi, C. S., Kharawala, S., Kaur, G., & Schmidt, J. (2019) · Medical Devices Evidence and Research · doi:10.2147/mder.s198943 · Cited by 25
“In a randomized study of 220 children aged 6–15 years with asthma exacerbation treated with ICS, audiovisual reminder functions (AVRFs) on the SmartInhalerTM device used with a preventer inhaler was either enabled (intervention group) or disabled (control group).(48) The follow-up period was 6 months, and adherence wa…”
Method
Tailored medication adherence incentives for high-risk children with asthma: a pilot study
Kenyon, C. C., Sundar, K. G., Gruschow, S. M., Quarshie, W. O., Feudtner, C., Bryant-Stephens, T. C., & Miller, V. A. (2019) · Journal of Asthma · doi:10.1080/02770903.2019.1648503 · Cited by 24
The effect of electronic monitoring combined with weekly feedback and reminders on adherence to inhaled corticosteroids in infants and younger children with asthma: a randomized controlled trial
Chen, J., Xu, J., Zhao, L., Zhang, J., Yin, Y., & Zhang, F. (2020) · Allergy Asthma and Clinical Immunology · doi:10.1186/s13223-020-00466-6 · Cited by 25
Transitioning Asthma Care From Adolescents to Adults
Nanzer, A. M., Lawton, A., d’Ancona, G., & Gupta, A. K. (2021) · CHEST Journal · doi:10.1016/j.chest.2021.05.019 · Cited by 25

Authors: Chan, A. H. Y., Stewart, A. W., Harrison, J., Camargo, C. A., Black, P. N., & Mitchell, E. A.
Affiliations: University of Auckland (NZ)
Harvard University (US)
Corresponding author: Chan, Amy H Y
ORCID: Chan, Amy H Y
Stewart, Alistair W
Harrison, Jeff
Camargo, Carlos A
Mitchell, Edwin A
Venue: The Lancet Respiratory Medicine
Publisher: Elsevier BV
Published: 2015-03
Volume: 3
Issue: 3
Pages: 210-219
ISSN: 2213-2600 (ISSN-L)
DOI: 10.1016/s2213-2600(15)00008-9
OpenAlex: W2164117859
Cited by: 265
References: 60
Citations by year: 2026: 19 · 2025: 21 · 2024: 25 · 2023: 21 · 2022: 21 · 2021: 22 · 2020: 25 · 2019: 37 · 2018: 27 · 2017: 22 · 2016: 18 · 2015: 6
FWCI: 28.28
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: The Lancet Respiratory Medicine (publishedVersion)
PubMed (publishedVersion)
UCL Discovery (University College London) (submittedVersion)
ResearchSpace (University of Auckland) (submittedVersion)
Topics: Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Asthma and respiratory diseases
Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
Keywords: medication adherence, inhaled corticosteroids, asthma, electronic monitoring devices, school attendance, asthma exacerbations, emergency department, children, asthma control, inhaler devices
MeSH terms: Absenteeism, Administration, Inhalation, Adolescent, Adrenal Cortex Hormones, Asthma, Child, Equipment Design, Humans, New Zealand, Schools, Treatment Outcome, Reminder Systems, Monitoring, Ambulatory, Anti-Asthmatic Agents, Medication Adherence

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The effect of an electronic monitoring device with audiovisual reminder function on adherence to inhaled corticosteroids and school attendance in children with asthma: a randomised controlled trial

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