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Clinical Impact of Electronic Monitoring Devices of Inhalers in Adults with Asthma or COPD: A Systematic Review and Meta-Analysis. Pharmaceuticals (Basel) 2023; 16:ph16030414. [PMID: 36986513 PMCID: PMC10055893 DOI: 10.3390/ph16030414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/11/2023] Open
Abstract
We conducted a systematic review and meta-analysis to gain insight into the characteristics and clinical impact of electronic monitoring devices of inhalers (EMDs) and their clinical interventions in adult patients with asthma or COPD. The search included PubMed, Web of Science, Cochrane, Scopus and Embase databases, as well as official EMDs websites. We found eight observational studies and ten clinical trials, assessing a wide range of clinical outcomes. Results from the meta-analysis on adherence to inhalers in a period over three months were favourable in the EMD group (fixed effects model: SMD: 0.36 [0.25–0.48]; random effects model SMD: 0.41 [0.22–0.60]). An exploratory meta-analysis found an improvement in ACT score (fixed effect model SMD: 0.25 [0.11–0.39]; random effects model: SMD: 0.47 [−0.14–1.08]). Other clinical outcomes showed mixed results in the descriptive analyses. The findings of this review highlight the benefits of EMDs in the optimization of adherence to inhaled therapy as well as the potential interest in other clinical outcomes.
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Eilayyan OJ, Arafah AM. Acceptance and Dropout Rates of Individuals with Asthma Approached in Self-management Interventions: A Systematic Review and Meta-analysis. JOURNAL OF HEALTH MANAGEMENT 2023. [DOI: 10.1177/09720634221150970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Objective The objectives of this systematic review were to assess the acceptability of self-management interventions for people with asthma and identify contributing factors. Methods A systematic literature search was conducted using PubMed, MEDLINE, EMBASE (OVIDWEB), CINAHL and Cochrane databases. Clinical trials design was included if they met specified criteria. A random-effect meta-regression analysis was conducted to estimate the overall acceptance and drop-out rates and to assess the potential factors that may influence the outcomes. Results A total of 64 studies were included and 8,092 participants were recruited and participated in the trials. The estimated acceptance rate was 51.1%, while the estimated drop-out rates in the intervention and control groups were 18.2% and 15.6%, respectively. Lack of interest was the main reported reason for refusing to participate and dropping out from the program. Study-related and program-related factors influenced the acceptance and drop-out rates statistically and clinically. Conclusion The acceptance rate of self-management programs among asthmatic people was not high and the dropout rate was somewhat low. The review suggests optimizing the design of self-management studies and modifying the implemented self-management programs to increase the acceptance rate and decrease the dropout rate.
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Affiliation(s)
- Owis J. Eilayyan
- Physical Therapy Department, Faculty of Allied Medical Sciences, Aqaba University of Technology, Aqaba, Jordan
| | - Alaa M. Arafah
- Faculty of Medical Rehabilitation Sciences, Department of Occupational Therapy, King Abdulaziz University, Jeddah, Saudi Arabia
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Tay TR, van Boven JFM, Chan A, Hew M. Electronic Inhaler Monitoring for Chronic Airway Disease: Development and Application of a Multidimensional Efficacy Framework. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1189-1201.e1. [PMID: 34915225 DOI: 10.1016/j.jaip.2021.11.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/12/2021] [Accepted: 11/23/2021] [Indexed: 06/14/2023]
Abstract
Inhaled therapy is the cornerstone of chronic airway disease therapy, but poor adherence to controller inhalers worsens clinical outcomes and increases cost. Monitoring of controller use is needed to improve adherence, and monitoring of reliever use can predict impending exacerbations. Both can be accurately achieved by electronic inhaler monitoring (EIM). However, evidence for EIM use in clinical practice is limited and varied, and knowledge gaps remain across different outcomes and health settings. We aimed to develop a framework to assess EIM systematically across all aspects of efficacy, apply this framework to the current literature, and identify gaps in efficacy to inform future development in the field. We adapted an existing framework for diagnostic tests, consisting of six levels of efficacy with ascending clinical relevance: technical, diagnostic accuracy, diagnostic thinking, therapeutic, patient outcome, and societal efficacy. Tailoring this framework to EIM, we incorporated expert feedback and applied it to the EIM efficacy literature. We found that EIM has good diagnostic accuracy, diagnostic thinking, and therapeutic efficacies, but evidence is lacking for specific aspects of technical, patient outcome, and societal efficacies. Further development of EIM requires improved reliability, usability, and data security for patients, and optimal integration with electronic medical records and overall patient care. Defining appropriate target patient groups and pairing EIM data with effective interventions, in conjunction with reducing costs through technological innovation and economies of scale, will enhance patient and societal outcome efficacies.
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Affiliation(s)
- Tunn Ren Tay
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
| | - Job F M van Boven
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, University of Groningen, Groningen, the Netherlands; Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia; Medication Adherence Expertise Center of the Northern Netherlands, Groningen, the Netherlands
| | - Amy Chan
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Mark Hew
- Allergy, Asthma, and Clinical Immunology, Alfred Hospital, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
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Drummond D. Outils connectés pour la télésurveillance des patients asthmatiques : gadgets ou révolution? Rev Mal Respir 2022; 39:241-257. [DOI: 10.1016/j.rmr.2022.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/07/2022] [Indexed: 11/28/2022]
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Şanlıtürk D, Ayaz-Alkaya S. The Effect of a Theory of Planned Behavior Education Program on Asthma Control and Medication Adherence: A Randomized Controlled Trial. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:3371-3379. [PMID: 33930620 DOI: 10.1016/j.jaip.2021.03.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 03/08/2021] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Disease management in individuals with asthma is affected by factors such as avoiding triggers that cause attacks and properly using inhaler devices. OBJECTIVE To determine the effect of a theory of planned behavior (TPB) education program on asthma control and medication adherence. METHODS A randomized controlled trial enrolled 30 participants in the intervention group and 30 in the control group. The educational approach was employed in participants in the intervention group for five home visits over 3 months according to the TPB program. RESULTS Before the education program, all participants in the intervention group and 90% of those in the control group had poorly controlled asthma (P > .05). After the program, all individuals in the intervention group and 20% of the control group had well-controlled asthma (P < .001). There was no statistically significant difference between Morisky Medication Adherence Scale-8 pretest scores in the intervention and control groups in terms of medication adherence (2.37 ± 1.75 and 3.13 ± 1.71, respectively; P > .05). Mean Morisky Medication Adherence Scale-8 scores in the intervention group at posttest (7.50 ± 0.78) were significantly higher than those of the control group (3.93 ± 2.03; P < .001. CONCLUSIONS This study revealed that asthma control and medication adherence increased in the intervention group after the TPB education program. The program was effective in asthma control and medication adherence for individuals with asthma.
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Affiliation(s)
- Döndü Şanlıtürk
- Nursing Department, Health School, Tokat Gaziosmanpaşa University, Tokat, Turkey
| | - Sultan Ayaz-Alkaya
- Nursing Department, Faculty of Health Sciences, Gazi University, Ankara, Turkey.
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Mosnaim G, Safioti G, Brown R, DePietro M, Szefler SJ, Lang DM, Portnoy JM, Bukstein DA, Bacharier LB, Merchant RK. Digital Health Technology in Asthma: A Comprehensive Scoping Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2377-2398. [PMID: 33652136 DOI: 10.1016/j.jaip.2021.02.028] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/04/2021] [Accepted: 02/04/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND A variety of digital intervention approaches have been investigated for asthma therapy during the past decade, with different levels of interactivity and personalization and a range of impacts on different outcome measurements. OBJECTIVE To assess the effectiveness of digital interventions in asthma with regard to acceptability and outcomes and evaluate the potential of digital initiatives for monitoring or treating patients with asthma. METHODS We evaluated digital interventions using a scoping review methodology through a literature search and review. Of 871 articles identified, 121 were evaluated to explore intervention characteristics, the perception and acceptability of digital interventions to patients and physicians, and effects on asthma outcomes. Interventions were categorized by their level of interactivity with the patient. RESULTS Interventions featuring non-individualized content sent to patients appeared capable of promoting improved adherence to inhaled corticosteroids, but with no identified improvement in asthma burden; and data-gathering interventions appeared to have little effect on adherence or asthma burden. Evidence of improvement in both adherence and patients' impairment due to asthma were seen only with interactive interventions involving two-way responsive patient communication. Digital interventions were generally positively perceived by patients and physicians. Implementation was considered feasible, with certain preferences for design and features important to drive use. CONCLUSIONS Digital health interventions show substantial promise for asthma disease monitoring and personalization of treatment. To be successful, future interventions will need to include both inhaler device and software elements, combining accurate measurement of clinical parameters with careful consideration of ease of use, personalization, and patient engagement aspects.
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Affiliation(s)
- Giselle Mosnaim
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, North Shore University Health System, Evanston, Ill
| | | | - Randall Brown
- Teva Branded Pharmaceutical Products R&D, Inc, West Chester, Pa
| | - Michael DePietro
- Teva Branded Pharmaceutical Products R&D, Inc, West Chester, Pa.
| | - Stanley J Szefler
- The Breathing Institute and Pulmonary Medicine Section, Children's Hospital Colorado and University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
| | - David M Lang
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jay M Portnoy
- Pediatric Allergy and Immunology, Children's Mercy Hospital, Kansas City School of Medicine, Kansas City, Mo
| | - Don A Bukstein
- Allergy, Asthma and Sinus Center, Milwaukee, Greenfield, Wis
| | - Leonard B Bacharier
- Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt University Medical Center, Nashville, Tenn
| | - Rajan K Merchant
- Woodland Clinic Medical Group, Allergy Department, Dignity Health, Woodland, Calif
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Poowuttikul P, Seth D. New Concepts and Technological Resources in Patient Education and Asthma Self-Management. Clin Rev Allergy Immunol 2021; 59:19-37. [PMID: 32215784 DOI: 10.1007/s12016-020-08782-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Asthma is a chronic disease that is associated with significant morbidity and mortality. In general, the use of technology resources or electronic health (e-health) has been shown to have beneficial effects on patients with asthma. E-health can impact a broad section of patients and can be cost-effective and associated with high patient satisfaction. E-health may enable remote delivery of care, as well as timely access to health care, which are some of the common challenges faced by patients with asthma. Web-based asthma self-management systems have been found to improve quality of life, self-reported asthma symptoms, lung function, reduction in asthma symptoms/exacerbations, and self-reported adherence for adults. Social media is commonly being used as a platform to disseminate information on asthma to increase public awareness. It can facilitate asthma self-management in a patient friendly manner and has shown to improve asthma control test scores as well as self-esteem. Text massages reminders can increase awareness regarding asthma treatment and control, thus potentially can improve adherence to medications and asthma outcome. Mobile health applications can support asthma self-management, improve a patient's quality of life, promote medication adherence, and potentially reduce the overall costs for asthma care. Inhaler trackers have shown to be beneficial to asthma outcome in various populations by improving adherence to asthma medications. Barriers such as physician financial reimbursement as well as licensing for rendering tele-healthcare services are important concerns. Other limitations of using technology resources in health care are related to liability, professionalism, and ethical issues such as breach of patient confidentiality and privacy. Additionally, there may be less face-to-face interaction and care of the patient when e-health is used.
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Affiliation(s)
- Pavadee Poowuttikul
- Department of Pediatrics, Division of Allergy/Immunology, Children's Hospital of Michigan, Wayne State University School of Medicine, 3950 Beaubien, 4th Floor, Pediatric Specialty Building, Detroit, MI, 48201, USA.
| | - Divya Seth
- Department of Pediatrics, Division of Allergy/Immunology, Children's Hospital of Michigan, Wayne State University School of Medicine, 3950 Beaubien, 4th Floor, Pediatric Specialty Building, Detroit, MI, 48201, USA
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Tibble H, Chan A, Mitchell EA, Horne E, Doudesis D, Horne R, Mizani MA, Sheikh A, Tsanas A. A data-driven typology of asthma medication adherence using cluster analysis. Sci Rep 2020; 10:14999. [PMID: 32929109 PMCID: PMC7490405 DOI: 10.1038/s41598-020-72060-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 08/20/2020] [Indexed: 11/17/2022] Open
Abstract
Asthma preventer medication non-adherence is strongly associated with poor asthma control. One-dimensional measures of adherence may ignore clinically important patterns of medication-taking behavior. We sought to construct a data-driven multi-dimensional typology of medication non-adherence in children with asthma. We analyzed data from an intervention study of electronic inhaler monitoring devices, comprising 211 patients yielding 35,161 person-days of data. Five adherence measures were extracted: the percentage of doses taken, the percentage of days on which zero doses were taken, the percentage of days on which both doses were taken, the number of treatment intermissions per 100 study days, and the duration of treatment intermissions per 100 study days. We applied principal component analysis on the measures and subsequently applied k-means to determine cluster membership. Decision trees identified the measure that could predict cluster assignment with the highest accuracy, increasing interpretability and increasing clinical utility. We demonstrate the use of adherence measures towards a three-group categorization of medication non-adherence, which succinctly describes the diversity of patient medication taking patterns in asthma. The percentage of prescribed doses taken during the study contributed to the prediction of cluster assignment most accurately (84% in out-of-sample data).
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Affiliation(s)
- Holly Tibble
- Usher Institute, Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Doorway 1, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK.
- Asthma UK Centre for Applied Research, Usher Institute, Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK.
| | - Amy Chan
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Centre for Behavioural Medicine, Department for Practice and Policy, UCL School of Pharmacy, University College London, London, UK
| | - Edwin A Mitchell
- Department of Paediatrics: Child and Youth Health, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Elsie Horne
- Usher Institute, Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Doorway 1, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
- Asthma UK Centre for Applied Research, Usher Institute, Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK
| | - Dimitrios Doudesis
- Usher Institute, Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Doorway 1, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
- BHF Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK
| | - Rob Horne
- Asthma UK Centre for Applied Research, Usher Institute, Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK
- Centre for Behavioural Medicine, Department for Practice and Policy, UCL School of Pharmacy, University College London, London, UK
| | - Mehrdad A Mizani
- Usher Institute, Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Doorway 1, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
- Asthma UK Centre for Applied Research, Usher Institute, Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK
| | - Aziz Sheikh
- Usher Institute, Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Doorway 1, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
- Asthma UK Centre for Applied Research, Usher Institute, Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK
- Health Data Research UK, London, UK
| | - Athanasios Tsanas
- Usher Institute, Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Doorway 1, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
- Asthma UK Centre for Applied Research, Usher Institute, Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK
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Singh N, Varshney U. IT-based reminders for medication adherence: systematic review, taxonomy, framework and research directions. EUR J INFORM SYST 2019. [DOI: 10.1080/0960085x.2019.1701956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Neetu Singh
- Department of Management Information Systems, University of Illinois at Springfield, Springfield, Illinois
| | - Upkar Varshney
- Department of Computer Information Systems, J. Mack Robinson College of Business, Georgia State University, Atlanta, Georgia
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