Electronic monitoring of adherence to inhaled corticosteroids: an essential tool in identifying severe asthma in children
Open accessAbstract
International guidelines recommend that severe asthma can only be diagnosed after contributory factors, including adherence, have been addressed. Accurate assessment of adherence is difficult in clinical practice. We hypothesised that electronic monitoring in children would identify nonadherence, thus delineating the small number with true severe asthma.Asthmatic children already prescribed inhaled corticosteroids were prospectively recruited and persistence of adherence assessed using electronic monitoring devices. Spirometry, airway inflammation and asthma control were measured at the start and end of the monitoring period.93 children (62 male; median age 12.4 years) were monitored for a median of 92 days. Median (range) monitored adherence was 74% (21-99%). We identified four groups: 1) good adherence during monitoring with improved control, 24% (likely previous poor adherence); 2) good adherence with poor control, 18% (severe therapy-resistant asthma); 3) poor adherence with good control, 26% (likely overtreated); and 4) poor adherence with poor control, 32%. No clinical parameter prior to monitoring distinguished these groups.Electronic monitoring is a useful tool for identifying children in whom a step up in treatment is indicated. Different approaches are needed in those who are controlled when adherent or who are nonadherent. Electronic monitoring is essential in a paediatric severe asthma clinic.
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Despite interventions and treatments aimed at addressing modifiable factors and comorbidities, some children with difficult asthma and Asthma plus may not improve because of continued poor adherence with medications or ongoing high exposure to allergens, in which case they should be considered as having refractory difficult asthma or refractory Asthma plus.
“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 [50]
The limitation of the use of maximum treatment is that there may be different reasons for poor asthma control among patients on maximum treatment, such as wrong diagnosis, non-adherence with medication, or therapy-resistant disease.
“The limitation of the use of “maximum treatment” is that there may be different reasons for poor asthma control among patients on “maximum treatment,” such as the wrong diagnosis (46), non-adherence with medication (50), or therapy-resistant disease (48).”
From Epidemiology of Asthma in Children and Adults (2019) · cites this paper as [50]
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- Authors
- Jochmann, A., Artusio, L., Jamalzadeh, A., Nagakumar, P., Delgado-Eckert, E., Saglani, S., Bush, A., Frey, U., & Fleming, L. J.
- Affiliations
- University of Basel (CH)
- Royal Brompton Hospital (GB)
- ORCID
- Venue
- European Respiratory Journal
- Publisher
- European Respiratory Society (ERS)
- Published
- 2017-12
- Volume
- 50
- Issue
- 6
- Pages
- 1700910
- ISSN
- 0903-1936 (ISSN-L)
- 1399-3003
- OpenAlex
- W2777461381
- Cited by
- 104
- References
- 29
- Citations by year
- 2026: 7 · 2025: 4 · 2024: 8 · 2023: 8 · 2022: 6 · 2021: 16 · 2020: 21 · 2019: 25 · 2018: 7 · 2017: 1
- FWCI
- 15.42
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Respiratory Journal (publishedVersion)
- PubMed (publishedVersion)
- edoc (University of Basel) (acceptedVersion)
- Spiral (Imperial College London) (submittedVersion)
- edoc (University of Basel)
- Funders
- Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (P2SKP3_151971)
- Asthma UK Innovations (AUK-IG-2014-284)
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Keywords
- electronic medication monitoring, medication adherence, inhaled corticosteroids, severe asthma, childhood asthma, asthma control, airway inflammation, therapy-resistant asthma, overtreatment, treatment escalation
- MeSH terms
- Administration, Inhalation, Adolescent, Adrenal Cortex Hormones, Asthma, Child, Child, Preschool, Female, United Kingdom, Humans, Male, Prospective Studies, Drug Monitoring, Anti-Asthmatic Agents, Electrical Equipment and Supplies
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