The DOI matches its Crossref record; 60 of the 60 references it cites were found in a registry or an index.
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
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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“However, despite interventions and treatments aimed at addressing modifiable factors and comorbidities, some children with DA and Asthma plus may not improve [e.g., because of the continued poor adherence with medications (50, 68), or ongoing high exposure to allergens (69–71)], in which case they should be considered as having refractory DA or refractory Asthma plus (46, 72).”
From Epidemiology of Asthma in Children and Adults (2019) · cites this paper as [68]
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“Chan evaluates the effects of using electronic monitoring devices for adherence to inhaled corticosteroids, whilst Migliozzi looks at controlling blood pressure using home monitoring (Chan et al., 2015; Migliozzi et al., 2015).”
BackgroundInhalable Nanotechnology-Based Drug Delivery Systems for the Treatment of Inflammatory Lung Diseases
Mahmoud, D. E., Hosseini, S. H., Rathore, H. A., Alkilany, A. M., Heise, A., & Elhissi, A. M. A. (2025) · Pharmaceutics · doi:10.3390/pharmaceutics17070893 · Cited by 30
“The results illustrated that the use of such electronic monitoring led to a significant enhancement in adherence, and showed promising potential for improving asthma control in those with inadequate control due to poor adherence [175].”
Criner, G. J., Cole, T., Hahn, K. A., Kastango, K. B., Eudicone, J. M., & Gilbert, I. (2021) · International Journal of COPD · doi:10.2147/copd.s253770 · Cited by 24
“A separate study of medication reminders in children with asthma also reported significant improvements in adherence.(10) “Connected devices”—for example, a medical device that wraps around the patient’s pressurized metered-dose inhaler (pMDI) and, with patient consent, transmits medical information to a health care p…”
BackgroundResultvan de Hei, S. J., Poot, C. C., van den Berg, L. N., Meijer, E., van Boven, J. F. M., Flokstra-de Blok, B. M. J., Postma, M. J., Chavannes, N. H., & Kocks, J. W. H. (2022) · BMJ Open Respiratory Research · doi:10.1136/bmjresp-2022-001400 · Cited by 22
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“A systemic review shows a weak to moderate impact with these systems, with diminishing effects after 4 weeks of use, reflecting habituation to reminders, especially if the reminder is automated [103,104].”
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“The remaining 5 studies were recruited from or associated with a hospital emergency department [29,30], community pharmacies [25,33,34], outpatient appointments in a hospital or Asthma Clinic [40], Howard University [39], and impoverished, rural school districts [37].”
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Bender, B. G., Oppenheimer, J., George, M., Brown, R. W., Patel, A. K., Hill, T. D., Boe, A., Herrera, E. M., Dotiwala, Z., Casciano, J. P., et al. (2022) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2022.07.016 · Cited by 22
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“Instead, we used EMDs in order to increase the validity and reliability of our results [5,10,26].”
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“old, using the same device as the Auckland trial, had 70% adherence to ICS, compare to 49% among controls (11,12).”
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“Currently, the cost of a smart nebulizer is still fairly high, and most devices are still in the clinical research stage although the cost of longterm therapy in asthma may be reduced with significant improvement of adherence rate.(26,28) In the current study, not only the health care cost, but also frequency of respi…”
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“Three high‐ reliability and effective intervention studies did not meet the criteria for Level 3 PAPA.(22,29,40) Overall, only two of the high‐reliability studies based on Level 3 PAPA did not result in effective interventions.”
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“EIMDs, in combination with audiovisual reminders and feedback, have the potential to improve medication adherence and health care outcomes by facilitating self-management and aiding in clinical (shared) decision making [8-15].”
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“Notably, randomized controlled trials using these technologies have demonstrated the effectiveness of electronic medication use monitoring, including electronic reminders and feedback, in improving adherence and achieving asthma control [13-15].”
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“There are precedents for monitoring and feedback in asthma, for example, monitoring and feedback of medication use is acceptable and has been shown to increase medication use in adults and children [22,23].”
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Busaidi, N. A., Alweqayyan, A. A., Zaabi, A. A., Mahboub, B., Alhuraish, F., Hameed, M. A., Al-Ahmad, M. S., Khadadah, M. E., Lawati, N. A., Behbehani, N., et al. (2022) · The Open Respiratory Medicine Journal · doi:10.2174/18743064-v16-e2205230 · Cited by 17
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“74 A prospective cohort study using EMDs to monitor drug use adherence in children with asthma demonstrated the clinical usefulness of using objective monitoring tools to assess adherence, which can help distinguish DA from STRA in problematic severe asthma.”
Pathogenesis and prevention strategies of severe asthma exacerbations in children
Cook, J., & Saglani, S. (2015) · Current Opinion in Pulmonary Medicine · doi:10.1097/mcp.0000000000000223 · Cited by 14
Two Sides of the Same Coin?—Treatment of Chronic Asthma in Children and Adults
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van de Hei, S. J., van den Berg, L. N., Poot, C. C., Gerritsma, Y. H., Meijer, E., Blok, B. M. J. F.-D., Postma, M. J., van Boven, J. F. M., Chavannes, N. H., & Kocks, J. W. H. (2025) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2025.03.013 · Cited by 13
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Incorporating technology to advance asthma controller adherence
Anderson, W. C. (2017) · Current Opinion in Allergy and Clinical Immunology · doi:10.1097/aci.0000000000000343 · Cited by 13
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Automated Adherence Reminders for High Risk Children With Asthma: A Research Protocol
Adams, S. A., Leach, M., Feudtner, C., Miller, V. A., & Kenyon, C. C. (2017) · JMIR Research Protocols · doi:10.2196/resprot.6674 · Cited by 11
“New reminder systems that leverage mobile technology have demonstrated promise in improving adherence in certain populations [18,19,35], but how these technologies and interventions may work in cohorts with the highest levels of asthma morbidity and death has not been thoroughly investigated.”
BackgroundCOUNTERPOINT: Will New Anti-eosinophilic Drugs Be Useful in Asthma Management? No
Barnes, P. J. (2016) · CHEST Journal · doi:10.1016/j.chest.2016.09.023 · Cited by 11
“It would be much more cost-effective to use other strategies to address poor adherence with ICS, such as using a reliever medication that contains a corticosteroid, such as maintenance and reliever therapy using ICS/formoterol combination inhalers(13) or by electronic monitoring of ICS use with an audiovisual reminder…”
BackgroundCushing, C. C., Fedele, D. A., Patton, S. R., McQuaid, E. L., Smyth, J. M., Prabhakaran, S., Gierer, S. A., Koskela-Staples, N. C., Ortega, A., Fleming, K., et al. (2019) · BMJ Open · doi:10.1136/bmjopen-2019-030029 · Cited by 11
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Aerosol Therapy in Asthma–Why We Are Failing Our Patients and How We Can Do Better
Morton, R., Elphick, H., Craven, V., Shields, M. D., & Kennedy, L. (2020) · Frontiers in Pediatrics · doi:10.3389/fped.2020.00305 · Cited by 10
The evolving landscape of digital inhaler platforms and adherence support in chronic airways disease
Aung, H. W. W., Murphy, A., & Greening, N. J. (2025) · Chronic Respiratory Disease · doi:10.1177/14799731251366969 · Cited by 9
“Charles et al. 56 reported a mean (SD) adherence rate (AR) of 88% (16) in the intervention group compared to 66% (27) in the control group, while Chan et al. 58 found a median AR difference of 54%.”
Smart inhalers in paediatric asthma: bridging the gap between innovation and clinical practice
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Asthma Management for Children
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Defining adherence phenotype and endotypes to personalise asthma management
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“Technology-enhanced reminders have demonstrated robust inhaled corticosteroid adherence improvements in countries outside of the United States [8-10].”
Brennan, V., Mulvey, C., Greene, G., MacHale, E., & Costello, R. W. (2021) · Frontiers in Medical Technology · doi:10.3389/fmedt.2021.604475 · Cited by 8
“Adherium—Hailie (formerly SmartInhaler) (25)”
BackgroundBenfante, A., Principe, S., Cicero, M. N., Incandela, M., Seminara, G., Durante, C., & Scichilone, N. (2021) · Pulmonary Pharmacology & Therapeutics · doi:10.1016/j.pupt.2021.102083 · Cited by 8
“4 Devices (EMDs) are now considered the gold standard to monitor adherence to treatment for asthma considering that they provide objective data, not biased by patient self-report, which increase its feasibility in children [15,16].”
BackgroundSupported self-management in asthma
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Currently Available Inhaled Therapies in Asthma and Advances in Drug Delivery and Devices
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“The device monitors medication adherence and coupled with a mobile application and cloud-based platform, provides a comprehensive solution aimed at improving adherence and reducing asthma exacerbation [42, 43].”
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Tailored Adherence Incentives for Childhood Asthma Medications
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Adherence to medicine in adolescence
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Monitoring and adherence in asthma management
Szefler, S. J. (2015) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(15)00009-0 · Cited by 7
Utilizing convolution neural networks for the acoustic detection of inhaler actuations
Kikidis, D., Votis, K., & Tzovaras, D. K. (2015) · E-Health and Bioengineering Conference (EHB) · doi:10.1109/ehb.2015.7391477 · Cited by 7
“A number of review studies have focused on the comparison of such devices and have led to useful results regarding their technical characteristics and their great potential for the improvement of asthma treatment [15-17].”
BackgroundImproving Asthma Outcomes in the Digital Era: A Systematic Review
Biblowitz, K., Bellam, S. K., & Mosnaim, G. S. (2018) · Pharmaceutical Medicine · doi:10.1007/s40290-018-0233-y · Cited by 7
“Two of the three EMDs, zero of the five mobile applications, zero of the 11 web portals, and three of the seven multimodal interventions showed objectively measured improvement in controller medication adherence.”
BackgroundResultInfluentialThe efficacy of a novel monitoring device on asthma control in children with asthma
Behrooz, L., Dilley, M. A., Petty, C. R., Huffaker, M. F., Sheehan, W. J., & Phipatanakul, W. (2020) · Annals of Allergy Asthma & Immunology · doi:10.1016/j.anai.2020.06.025 · Cited by 7
Moving toward consensus on diagnosis and management of severe asthma in children
Larenas‐Linnemann, D. E., Nieto, A., Palomares, Ó., Pitrez, P. M., & Cukier, G. (2017) · Current Medical Research and Opinion · doi:10.1080/03007995.2017.1400961 · Cited by 6
Use of Digital Health in Pediatric Asthma
Baker, J., & Berlinski, A. (2025) · Respiratory Care · doi:10.1089/respcare.12574 · Cited by 7
Monitoring adherence in children with asthma
Wong, C.-H., & Morton, R. (2021) · Paediatrics and Child Health · doi:10.1016/j.paed.2021.04.004 · Cited by 6
Feedback systems in multi-dose dry powder inhalers
Emeryk, A., & Janeczek, K. (2022) · Advances in Dermatology and Allergology · doi:10.5114/ada.2022.117039 · Cited by 6
A Review of Sensor-Based Interventions for Supporting Patient Adherence to Inhalation Therapy
Ma, J., Sun, X., & Liu, B. (2024) · Patient Preference and Adherence · doi:10.2147/ppa.s485553 · Cited by 6
CHILDREN WITH BRONCHIAL ASTHMA: PROBLEMS OF COMLIANCE TO THERAPY
Ильенкова, Н. А., Викторовна, Ч. И., & Vokhmina, T. A. (2016) · Педиатрическая фармакология · doi:10.15690/pf.v13i6.1670 · Cited by 6
The Use of Health Technology to Enhance the Adherence of Tuberculosis Treatment: A Systematic Review
Sholikhah, D. U., Sari, G. M., Narendri, C. M., Sariati, S., & Purwanti, N. D. (2019) · Jurnal NERS · doi:10.20473/jn.v14i3.16982 · Cited by 6
Inhaler adherence in severe asthma: is there an electronic solution?
Gaga, M., Samitas, Κ., & Ζervas, Ε. (2018) · European Respiratory Journal · doi:10.1183/13993003.02219-2017 · Cited by 6
Jayamini, W. K. D., Mirza, F., Bidois-Putt, M.-C., Naeem, M. A., & Chan, A. H. Y. (2024) · JMIR Formative Research · doi:10.2196/59811 · Cited by 6
“…peak flow meter used to measure the airflow out of the lungs, and the smart inhaler used for taking medicines, integrated with mobile applications, can help the user automatically record peak flow readings and improve the use of inhaler medications with the audiovisual reminders respectively [6].”
Traidl, S., Lang, C. C. V., Schmid‐Grendelmeier, P., Werfel, T., & Heratizadeh, A. (2021) · Handbook of experimental pharmacology · doi:10.1007/164_2021_488 · Cited by 5
SMART INHALERS: HARNESSING IOT FOR PRECISE ASTHMA MANAGEMENT
Margam, R. (2024) · International Education and Research Journal · doi:10.21276/ierj24265450564586 · Cited by 5
Recent advances in paediatric respiratory medicine
Turnbull, A. R., & Balfour-Lynn, I. M. (2015) · Archives of Disease in Childhood · doi:10.1136/archdischild-2014-307212 · Cited by 5
Lim, Y. X., Choo, Y. N., Looi, Y. T., Chuan, Y. W., Chiam, K.-X., Wong, R. S. Y., Ng, N. C., & Goh, B. H. (2026) · Current Allergy and Asthma Reports · doi:10.1007/s11882-026-01265-6 · Cited by 4
Improving Medication Adherence in Asthma
Kerr, P., Brennan, V., MacHale, E., Doyle, F., & Costello, R. W. (2022) · Seminars in Respiratory and Critical Care Medicine · doi:10.1055/s-0042-1749636 · Cited by 5
Mobile Sensors and Wearable Technology
Yao, C. A., & Ho, K. (2017) · Springer eBooks · doi:10.1007/978-3-319-56103-5_7 · Cited by 4
Rungvivatjarus, T., Huang, M. Z., Winckler, B. E., Fisher, E. S., & Rhee, K. E. (2025) · Frontiers in Health Services · doi:10.3389/frhs.2025.1569531 · Cited by 3
Digital Respiratory Technologies Across the Lifespan
Chan, A. H. Y., Drummond, D., Moor, C. C., & van Boven, J. F. M. (2025) · CHEST Journal · doi:10.1016/j.chest.2025.08.019 · Cited by 3
Prise en charge thérapeutique et adaptation du traitement de fond
Drummond, D., Mazenq, J., Lezmi, G., Cros, P., Coutier, L., Desse, B., Divaret‐Chauveau, A., Dubus, J. ‐., Girodet, P., Kiefer, S., et al. (2024) · Revue des Maladies Respiratoires · doi:10.1016/j.rmr.2024.07.005 · Cited by 3
Hoang, Y. T. H., van Aalderen, W. M. C., Dellbrügger, E., Grenzbach, C., Grigg, J., Grittner, U., Haarman, E. G., Toro, C. J. H., Karadag, B. T., Roßberg, S., et al. (2024) · Pediatric Pulmonology · doi:10.1002/ppul.27295 · Cited by 3
“23 25 Moreover, structured self ‐ management interventions have proven effective in improving medication adherence, lung function and reducing missed school days, 26 – 28 marking them as a key component of future pediatric asthma care.”
Peng, Y., Chen, S., Zhong-ping, W., Lin, J., Huang, J., Lei, X., Ye, P., Zheng, J., & Gao, Y. (2024) · Respiratory Medicine and Research · doi:10.1016/j.resmer.2024.101095 · Cited by 3
“I just want to get on with my life”: adolescent psychology for respiratory clinicians
Stewart-Knight, K., & Carroll, S. (2024) · European Respiratory Society eBooks · doi:10.1183/2312508x.10011123 · Cited by 3
Koyuncu, A., & Ari, A. (2024) · Expert Review of Respiratory Medicine · doi:10.1080/17476348.2024.2361048 · Cited by 3
Evaluating digital adherence support in asthma: the ADITION non-interventional study
Woehrle, H., Driemert, J., Jerrentrup, L., Schiefer, C., Bushart, G., & Sauerbeck, I. S. (2024) · ERJ Open Research · doi:10.1183/23120541.00734-2024 · Cited by 3
“…is digital support, using app-based digital health tools, electronic inhalers and/or inhaler add-ons [9, 10], with studies showing that digital support can improve asthma control [11, 12] and adherence to maintenance medication [13, 14], and can avoid the need for add-on biological therapy [15].”
Jochmann, A., Artusio, L., Usemann, J., Jamalzadeh, A., Bush, A., Frey, U., & Fleming, L. (2021) · ERJ Open Research · doi:10.1183/23120541.00726-2020 · Cited by 3
“Asthma attacks, hospital admissions and asthma morbidity are reduced in patients with improved adherence after a period of electronic monitoring [6, 7].”
BackgroundTurner, S., Cotton, S. C., Wood, J., Bell, V., Raja, E. A., SCOTT, N. W., Morgan, H. M., Lawrie, L., Emele, C. D., Kennedy, C., et al. (2022) · Efficacy and Mechanism Evaluation · doi:10.3310/awoi5587 · Cited by 4
Inhaler adherence, associated factors and outcomes among adult asthma patients in Singapore
Lee, T., Teoh, K. J. A., Acharyya, S., Lee, S. Y., Tan, S. M., Coliat, C. M. D., Prabhakaran, L., Goh, C. Y., Azman, N. S. B., Hou, P., et al. (2025) · Singapore Medical Journal · doi:10.4103/singaporemedj.smj-2024-155 · Cited by 2
“[24] Lastly, prescribing a once‑daily low‑dose ICS regimen, rather than a twice‑daily regimen, has been associated with higher adherence rates and improved health‑ related quality of life.”
Systematic Review of Electronic Monitoring to Increase Medication Adherence in Children With Asthma
Hassani, M., Barrows, J., & Young, S. D. (2025) · Pediatric Pulmonology · doi:10.1002/ppul.71355 · Cited by 2
Telemonitoring in Respiratory Diseases: Current Evidence, Clinical Experience, and Future Challenges
Padilla, D. E. L., Poberezhets, V., Roche, N., Moor, C. C., Bruyneel, M., Ribeiro, C., & Pinnock, H. (2026) · Archivos de Bronconeumología · doi:10.1016/j.arbres.2026.01.001 · Cited by 2
Approach to difficult-to-treat asthma in childhood: a narrative review
Cheng, D.-T., Wee, L. Y. J., Teoh, O. H., & Thomas, B. (2024) · Singapore Medical Journal · doi:10.4103/singaporemedj.smj-2023-137 · Cited by 2
Metadata
- 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
- Venue
- The Lancet Respiratory Medicine
- Publisher
- Elsevier BV
- Published
- 2015-03
- Volume
- 3
- Issue
- 3
- Pages
- 210-219
- ISSN
- 2213-2600 (ISSN-L)
- 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
- 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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